Tracking Details - #1195

Tracking Information
Case No: 1111
Order Date: 12/04/2025
Due Date:
Template Packet: HIPAA Authorization Packet
Scope:
Location: 21st Century Optical Fashions
51 NY-111
Smithtown, NY 11787
Phone: 631-724-4545 • Fax: (631) 724-4575
Patient: Kendrick Lamar
DOB: 12/31/1992 • SSN: ***-**-4793
21st Century Optical Fashions
51 NY-111
Smithtown, NY 11787
Phone: 631-724-4545 • Fax: (631) 724-4575
Kendrick Lamar
DOB: 12/31/1992 • SSN: ***-**-4793
Requested Records
Record Status
Attendance Records Pending
File Name Uploaded Date Uploaded By
285048453759_20251204034026409.JPEG 2025-12-04
Tracking Step Log
Step Due Date Remarks Publish Entered
Received Order, In Progress Yes 12/3/2025 10:40 PM
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