Tracking Details - #3309

Tracking Information
Case No: 3129
Order Date: 01/29/2026
Due Date:
Template Packet: New York HIPAA Authorization Packet
Scope:
Location: 110 Pharmacy
459 Walt. Whitman Rd.
Melville, NY 11747
Phone: 631-421-5454 • Fax: 631-421-0437
Patient: Hugh Jackman
DOB: 11/11/1950 • SSN: ***-**-4516
110 Pharmacy
459 Walt. Whitman Rd.
Melville, NY 11747
Phone: 631-421-5454 • Fax: 631-421-0437
Current packet matches the recommended template: New York HIPAA Authorization Packet.
Hugh Jackman
DOB: 11/11/1950 • SSN: ***-**-4516
Requested Records
Record Status
Billing Pending
Films Pending
File Name Uploaded Date Uploaded By
HIPAA_Authorization_3309_20260129210538.pdf 2026-01-29
Tracking Step Log
Step Due Date Remarks Publish Entered
Received Order, In Progress Yes 1/29/2026 8:34 PM
Generation Dept - Printed Packet 1/30/2026 Yes 1/30/2026 2:06 AM
Fax sent 2/3/2026 No 2/3/2026 12:36 AM
Fax delivery confirmed 2/3/2026 Fax delivered (manual) No 2/3/2026 12:37 AM
Assigned To: 2/5/2026 Assigned To: UserNo=1006 [INITIAL] No 2/3/2026 12:37 AM
Called Facility 3/5/2026 Called 110 Pharmacy at 631-421-5454. Spoke with Jan. They advised Records are on the way. Yes 2/26/2026 9:33 PM
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