Tracking Details - #1191
Tracking Information
Case No: 1107
Order Date:
12/03/2025
Due Date:
—
Template Packet: HIPAA Authorization Packet
Scope:
—
Location: Amjad M. Ali, M.D., CHPP Infectious Disease at Smithtown
48 Rte 25A Ste. 308
Smithtown, NY 11787
Patient: Ryan Gosling
DOB: 07/20/2002
• SSN: ***-**-8151
Requested Records
| Record | Status |
|---|---|
| Billing | Pending |
| File Name | Uploaded Date | Uploaded By |
|---|---|---|
| 285048453759_20251203171657133.JPEG | 2025-12-03 |
Tracking Step Log
| Step | Due Date | Remarks | Publish | Entered |
|---|---|---|---|---|
| Received Order, In Progress | Yes | 12/3/2025 12:16 PM |
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