Medical Records Request Tracking Log PDF
Narrow layout to track provider record requests, methods, fees, and statuses without validation.
Medical records request log
Plain HTML inputs only. Narrow width. No validation logic.
| Request Date | Provider / Facility Name | Patient Name | Records Requested | Request Method | Fee Charged | Status / Notes | Actions |
|---|---|---|---|---|---|---|---|
Track HIPAA record requests. Plain buttons. No validation logic.
🔒 MANDATORY CODEX SAFETY FOOTER (INCLUDE VERBATIM)
Non-Negotiable Guardrails
- Do not modify global layout, header, footer, ads, analytics, or shared components
- Do not import @/components/ui/select or any unverified shadcn components
- Use native HTML inputs only
- Row add/remove buttons must be plain <button>
- No date math, no parsing, no calculations
- PDF builders must return Promise<Uint8Array>
- Always create Blobs using bytesToPdfBlob(bytes) from lib/pdf/bytes.ts
- Never include null in React-PDF style arrays
- No refactors
- Tool may only break itself
Safety notes
- Processing stays in your browser. PDFs generate locally—no uploads or accounts.
- Downloads use a secure PDF blob helper (no raw array buffers or workers required).
- Review details before sending; nothing here is legal advice or a substitute for local forms.