Tracking Details - #1262
Tracking Information
Case No: 1117
Order Date:
12/12/2025
Due Date:
—
Template Packet: HIPAA Authorization Packet
Scope:
—
Location: Active Life Health of New York
300 East Main Street, Suite 1
Smithtown, NY 11787
Phone: 631-656-8796
• Fax: 631-333-7322
Patient: Rihanna Fenty
DOB: 07/15/1950
• SSN: ***-**-8376
Requested Records
| Record | Status |
|---|---|
| Billing | Fulfilled |
| File Name | Uploaded Date | Uploaded By |
|---|---|---|
| Cannon document scanner_20251212160907065.pdf | 2025-12-12 |
Tracking Step Log
| Step | Due Date | Remarks | Publish | Entered |
|---|---|---|---|---|
| Received Order, In Progress | Yes | 12/12/2025 11:09 AM | ||
| Generation Dept - Printed Packet | 12/12/2025 | Yes | 12/12/2025 4:09 PM | |
| Fax sent | 2/8/2026 | No | 2/8/2026 5:49 PM | |
| Fax delivery confirmed | 2/8/2026 | Fax delivered (manual) | No | 2/8/2026 5:50 PM |
| Assigned To: | 2/10/2026 | Assigned To: UserNo=1006 [INITIAL] | No | 2/8/2026 5:50 PM |
| Received - All Records | Received - Records | Yes | 3/3/2026 4:21 AM |
Loading request packet...