Tracking Details - #1156

Tracking Information
Case No: 1094
Order Date: 10/20/2025
Due Date:
Template Packet: HIPAA Authorization Packet
Scope:
Location: 100% Chiropractic - Decatur
1605 Church St. Suite 665
Decatur, GA 30033
Phone: (404) 343-3304 • Fax: 2122131715
Patient: Idris Elba
DOB: 03/31/1951 • SSN: ***-**-7778
100% Chiropractic - Decatur
1605 Church St. Suite 665
Decatur, GA 30033
Phone: (404) 343-3304 • Fax: 2122131715
Idris Elba
DOB: 03/31/1951 • SSN: ***-**-7778
Requested Records
Record Status
Films Pending
Medical Pending
File Name Uploaded Date Uploaded By
HIPAA_Authorization_1156_20251021163956.pdf 2025-10-21
Tracking Step Log
Step Due Date Remarks Publish Entered
Received Order, In Progress Yes 10/20/2025 11:46 AM
Generation Dept - Printed Packet 10/23/2025 Yes 10/23/2025 8:49 PM
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