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Records Departments Contact Tracking
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Treatment/Medical/Education ProviderRecords Contact Name/TitlePhoneFaxMailing AddressType of ReleaseSubmission TypeAdditional Notes
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General HospitalJane Smith, Records Manager456-123-4567345-234-56783 Third St. Anytown, YY 12345Treatment Provider ReleaseFaxCall Jane to confirm fax
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City School DistrictJohn Smith, Data Analyst123-456-7890345-123-34564 Fourth St. Anytown, YY 12345SOAR Agency ReleaseEmail
Email John an encrypted email
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*Gray cells have drop-down pick lists that are populated from the "Pick Lists" sheet
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