Tracking Details - #4344

Tracking Information
Case No: 3129
Order Date: 02/04/2026
Due Date:
Template Packet: New York HIPAA Authorization Packet
Scope:
Location: 1195 SEI U Benefit & Pensions Fund
330 West 42nd Street, 9th Floor
New York, NY 10036
Phone: (646) 473-9200 • Fax: Records.Retention@1199Funds.org
Patient: Hugh Jackman
DOB: 11/11/1950 • SSN: ***-**-4516
1195 SEI U Benefit & Pensions Fund
330 West 42nd Street, 9th Floor
New York, NY 10036
Phone: (646) 473-9200 • Fax: Records.Retention@1199Funds.org
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_3129_20260204071135.pdf 2026-02-04
Tracking Step Log
Step Due Date Remarks Publish Entered
Received Order, In Progress Yes 2/4/2026 7:11 AM
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