Tracking Details - #148

Tracking Information
Case No: 92
Order Date: 09/11/2025
Due Date:
Template Packet: HIPAA Authorization Packet
Scope:
Location: 1199 SEIU Funds
498 Seventh Avenue
New York, NY 10018
Phone: (646) 473-9200 • Fax: Records.Retention@1199Funds.org
Patient: Nicole Kidman
DOB: 05/28/1957 • SSN: ***-**-7500
1199 SEIU Funds
498 Seventh Avenue
New York, NY 10018
Phone: (646) 473-9200 • Fax: Records.Retention@1199Funds.org
Nicole Kidman
DOB: 05/28/1957 • SSN: ***-**-7500
Requested Records
Record Status
Films Pending
Medical Pending
File Name Uploaded Date Uploaded By
HIPAA_Authorization_148_20250911220758.pdf 2025-09-11
Tracking Step Log
Step Due Date Remarks Publish Entered
Received Order, In Progress Yes 9/11/2025 10:07 PM
Generation Dept - Printed Packet 9/12/2025 Yes 9/12/2025 2:08 AM
Created Shipping Label/Generated Tracking Number Shipping Label Created. FedEx Tracking Number: 794913446640 No 9/12/2025 2:08 AM
Delivered to custodian (carrier confirmed) 11/21/2025 Delivered (manual) No 11/21/2025 6:43 PM
Assigned To: 11/23/2025 Assigned To: UserNo=1006 [INITIAL] No 11/21/2025 6:43 PM
Received Invoice From Custodian 2/23/2026 Yes 2/23/2026 6:26 PM
Received Invoice From Custodian 2/23/2026 Yes 2/23/2026 6:32 PM
Facility invoice paid 3/9/2026 Yes 3/2/2026 12:00 AM
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