Tracking Details - #76

Tracking Information
Case No: 45
Order Date: 08/01/2025
Due Date:
Template Packet: HIPAA Authorization Packet
Scope:
Location: Southwest Suffolk Medical
300 East Main Street, Suite 2
Smithtown, NY 11787
Phone: None • Fax: None
Patient: Joaquin Phoenix
DOB: 12/13/2004 • SSN: ***-**-1262
Southwest Suffolk Medical
300 East Main Street, Suite 2
Smithtown, NY 11787
Phone: None • Fax: None
Joaquin Phoenix
DOB: 12/13/2004 • SSN: ***-**-1262
Requested Records
Record Status
CT Films Fulfilled
File Name Uploaded Date Uploaded By
HIPAA_Authorization_76_20250927112020.pdf 2025-09-27
Tracking Step Log
Step Due Date Remarks Publish Entered
Received Order, In Progress Yes 8/1/2025 2:06 AM
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\45\RequestPackets\Tracking_76_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=1006 [INITIAL] No 11/9/2025 11:22 PM
Received Invoice From Custodian 1/21/2026 Yes 1/21/2026 6:01 AM
Received - All Records Received - Records Yes 2/26/2026 10:05 PM
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