Tracking Details - #12
Tracking Information
Case No: 27
Order Date:
07/05/2025
Due Date:
10/02/2025
Template Packet: HIPAA Authorization Packet
Scope:
—
Location: New York Community Hospital
Attn: Medical Records
2525 Kings Highway
Brooklyn, NY 11229
Phone: (718) 692-5300 / 718-692-5377 HIM
• Fax: MUST MAIL
Patient: Paul Rudd
DOB: 03/31/2000
• SSN: ***-**-7446
Requested Records
No records requested.
| File Name | Uploaded Date | Uploaded By |
|---|---|---|
| HIPAA_Authorization_12_20251003171313.pdf | 2025-10-03 |
Tracking Step Log
| Step | Due Date | Remarks | Publish | Entered |
|---|---|---|---|---|
| Generation Dept - Printed Packet | 10/3/2025 | Yes | 10/3/2025 9:13 PM | |
| Fax sent | 10/15/2025 | Fax sent [RC:] | No | 10/15/2025 4:02 PM |
| Order Closed | Yes | 2/27/2026 7:26 PM |
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