Tracking Details - #75

Tracking Information
Case No: 48
Order Date: 07/31/2025
Due Date: 07/31/2025
Template Packet: HIPAA Authorization Packet
Scope:
Location: Ambulatory Care Pharmacy
1500 E. Medical Center Drive
Ann Arbor, MI 48109
Phone: None • Fax: None
Patient: Andrew Garfield
DOB: 10/20/1952 • SSN: ***-**-9685
Ambulatory Care Pharmacy
1500 E. Medical Center Drive
Ann Arbor, MI 48109
Phone: None • Fax: None
Andrew Garfield
DOB: 10/20/1952 • SSN: ***-**-9685
Requested Records
Record Status
Billing Pending
Films Pending
Medical Pending
File Name Uploaded Date Uploaded By
HIPAA_Authorization_75_20250927112036.pdf 2025-09-27
Tracking Step Log
Step Due Date Remarks Publish Entered
Received Order, In Progress Yes 7/31/2025 10:54 PM
Generation Dept - Printed Packet 9/27/2025 Yes 9/27/2025 3:21 PM
Sent - Fax to Custodian 9/27/2025 Sent Fax to none@concordsends.com. File=D:\RecuperaRSFiles\CaseFiles\48\RequestPackets\Tracking_75_RequestPacket.pdf No 9/27/2025 3:22 PM
Fax delivery confirmed 11/9/2025 Fax delivered (manual) No 11/9/2025 11:22 PM
Assigned To: 11/11/2025 Assigned To: UserNo=1005 [INITIAL] No 11/9/2025 11:22 PM
Called Facility Called Ambulatory Care Pharmacy at None. Yes 1/16/2026 4:50 PM
Fax sent 2/28/2026 Fax sent [RC:2955007420007] Yes 2/28/2026 10:03 PM
Sent Custodian additional Fax of Request Packet 3/7/2026 Faxed Request Packet to 2122131715 (RequestNo 2138) Yes 2/28/2026 10:03 PM
Called Facility 3/7/2026 Called Ambulatory Care Pharmacy at Phone Number. Spoke with Janet. They advised They would send us what we need today. Yes 2/28/2026 10:04 PM
Assigned To: 3/11/2026 Assigned To: UserNo=1005 [INITIAL] No 3/9/2026 2:33 AM
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