Date/Time Patient Pt Status Age Sex DOB Location

4/28/2023 16:30 AARON PAULSEY P+Active 35 M 3/4/1988 Kingwood Clinic

4/28/2023 11:30 ADRIANA RAMIREZ P+Active 27 F 10/12/1995 Willowbrook Clinic
4/28/2023 14:45 ALAA BAHJAT Active 39 F 4/8/1984 Memorial Clinic
4/28/2023 16:15 ALIYAH COVARRUBIAS Active 8 F 8/3/2014 Memorial Clinic
4/28/2023 10:15 AMANDA ERP Active 30 F 11/20/1992 Willowbrook Clinic
4/28/2023 10:30 AMBER HOSEA Active 42 F 10/18/1980 Memorial Clinic
4/28/2023 15:00 AMY WOODS Active 30 F 4/1/1993 Kingwood Clinic
4/28/2023 10:00 ANDREW CORNWELL Active 24 M 5/5/1999 Kingwood Clinic
4/28/2023 17:00 ANGELINA RUBIO Active 12 F 12/10/2010 Memorial Clinic
4/28/2023 12:00 ASHLEY YOUNG Active 39 F 1/11/1984 Willowbrook Clinic
4/28/2023 13:45 ATIYA POINDEXTER Active 41 F 8/10/1981 Kingwood Clinic
4/28/2023 10:30 BEVERLY GRANIER Active 49 F 6/29/1973 Kingwood Clinic
4/28/2023 16:45 CARMELLA NIELSEN Active 49 F 7/31/1973 Willowbrook Clinic
4/28/2023 15:15 CAROLYN TIDWELL Active 57 F 9/18/1965 Kingwood Clinic
4/28/2023 14:15 CHELSEA RILES Active 8 F 7/6/2014 Willowbrook Clinic
4/28/2023 8:45 CHRISTINA SMITH Active 43 F 3/21/1980 Willowbrook Clinic
4/28/2023 9:15 CHRISTOPHER DEGGS Active 32 M 4/10/1991 Memorial Clinic
4/28/2023 14:30 CHRISTOPHER PENDER Active 45 M 3/24/1978 Willowbrook Clinic
4/28/2023 14:15 CLEO LEWIS Active 27 F 11/11/1995 Kingwood Clinic
4/28/2023 11:00 CONNOR MARTIN Active 12 M 7/20/2010 Willowbrook Clinic
4/28/2023 10:00 CYNTHIA ORJI P+Active 37 F 2/7/1986 Willowbrook TMS
4/28/2023 9:45 DAMEON RANDALL DENNIS Active 45 M 6/25/1977 Willowbrook Clinic
4/28/2023 16:15 DANA FERRERO Active 14 F 12/15/2008 Kingwood Clinic
4/28/2023 8:45 DANIELLE MONTESDEOCA Active 38 F 2/20/1985 Willowbrook Clinic
4/28/2023 12:15 DARIN THOMPSON Active 25 M 8/29/1997 Willowbrook Clinic
4/28/2023 9:15 DEBORAH CHAPMAN Active 67 F 3/24/1956 Willowbrook Clinic
4/28/2023 9:00 DENISE CHASTUN Active 63 F 10/25/1959 Kingwood Clinic
4/28/2023 14:00 DESIRE REYNOLDS Active 11 F 12/7/2011 Willowbrook Clinic
4/28/2023 11:45 ERICA VAN RIPER Active 34 F 4/12/1989 Willowbrook Clinic
4/28/2023 14:00 GAIL MARTIN Active 65 F 5/1/1958 Memorial Clinic
4/28/2023 10:30 GINA RAMSEY Active 58 F 11/11/1964 Willowbrook TMS
4/28/2023 15:30 GIZZA SANTOS Active 23 F 7/2/1999 Willowbrook Clinic
4/28/2023 17:00 GUADALUPE MUNOZ ARANHA Active 57 F 3/7/1966 Willowbrook Clinic
4/28/2023 12:45 GUADALUPE ZAMUDIO Active 83 F 2/20/1940 Willowbrook Clinic
4/28/2023 10:45 HAILEE LANCON Active 30 F 5/11/1993 Kingwood Clinic
4/28/2023 12:15 HOLLY ROOS Active 31 F 6/17/1991 Willowbrook Clinic
4/28/2023 12:30 IISHIA SINER Active 45 F 9/13/1977 Willowbrook Clinic
4/28/2023 12:45 JAMIE ROWE Active 37 F 10/16/1985 Willowbrook Clinic
4/28/2023 9:30 JASON KRETZSCHMAR Active 46 M 11/10/1976 Willowbrook Clinic
4/28/2023 16:30 JAVIAN RUBIO Active 9 M 10/4/2013 Memorial Clinic
4/28/2023 9:15 JENNIFER ESCOBAR Active 40 F 10/23/1982 Kingwood Clinic
4/28/2023 13:15 JESSICA BECKER Active 37 F 8/22/1985 Willowbrook Clinic
4/28/2023 15:15 JOHANNES JD SANCERNI Active 15 M 1/2/2008 Willowbrook Clinic
 4/28/2023 9:15 JOHNNY DIAZ Active 34 M 2/14/1989 Willowbrook Clinic
4/28/2023 13:00 JOSE MENDOZA Active 28 M 5/27/1994 Kingwood Clinic
4/28/2023 13:45 JOSELYN GOMEZ Active 15 F 7/6/2007 Memorial Clinic
4/28/2023 12:30 JUSTIN WILLIAMS Active 22 M 9/13/2000 Willowbrook Clinic
4/28/2023 10:00 JUSTYCE KING Active 19 F 6/10/2003 Willowbrook Clinic
4/28/2023 15:30 KAMDYN ZOZULYA Active 15 F 8/2/2007 Memorial Clinic
4/28/2023 15:30 KAY ROWE Active 60 F 2/2/1963 Kingwood Clinic
4/28/2023 14:30 KAYLA FULLER Active 24 F 7/22/1998 Memorial Clinic
4/28/2023 14:00 KAYLA JACKSON Active 30 F 4/12/1993 Kingwood Clinic
4/28/2023 13:15 KENDRICK HOUSE Active 14 M 2/9/2009 Memorial Clinic
4/28/2023 12:00 KENNETH CATLETT Active 73 M 12/24/1949 Willowbrook Clinic
4/28/2023 10:45 KIMM BRYSON Active 39 F 6/1/1983 Willowbrook Clinic
4/28/2023 15:00 KWANITA FIELDS Active 23 F 5/7/2000 Kingwood Clinic
4/28/2023 9:45 LAWANDA BARNETT Active 64 F 10/10/1958 Memorial Clinic
4/28/2023 8:30 MARCUS MARTIN Active 21 M 11/29/2001 Willowbrook Clinic
4/28/2023 13:30 MARY MONTOYA Active 33 F 10/4/1989 Willowbrook Clinic
4/28/2023 15:45 MAVIS TYLER Active 36 F 12/25/1987 Memorial Clinic
4/28/2023 15:15 MELANIE BAUTISTA ORGANIZ Active 20 F 9/17/2002 Kingwood Clinic
4/28/2023 15:15 MEREDITH CLARK Active 21 F 12/21/2001 Willowbrook Clinic
4/28/2023 14:30 MICHELLE ELLIS Active 41 F 10/10/1981 Kingwood Clinic
4/28/2023 9:45 MICHELLE SISSON Active 52 F 11/7/1970 Willowbrook Clinic
4/28/2023 13:00 MIGUEL VARELA Active 64 M 9/5/1958 Willowbrook TMS
4/28/2023 11:00 MYRNA FLORES Active 70 F 3/16/1953 Memorial Clinic
4/28/2023 10:45 NANCY FOYTLIN Active 64 F 3/18/1959 Willowbrook Clinic
4/28/2023 15:30 NATHAN THOMPSON Active 16 M 7/21/2006 Willowbrook Clinic
4/28/2023 10:15 NATHANIEL BARKER Active 60 M 6/4/1962 Kingwood Clinic
4/28/2023 16:00 OMAR MOHAMED Active 16 M 9/11/2006 Kingwood Clinic
4/28/2023 13:30 OMENA LUMBI Active 25 F 3/12/1998 Memorial Clinic
4/28/2023 13:30 OPE AKINBIYI P+Active 33 F 9/10/1989 Willowbrook Clinic
4/28/2023 15:00 PATRICIA CRUZ Active 72 F 11/7/1950 Willowbrook Clinic
4/28/2023 11:00 PEDRO J VIVES Active 71 M 5/1/1952 Willowbrook Clinic
4/28/2023 16:15 PEDRO LOREDO Active 36 M 1/11/1987 Willowbrook Clinic
4/28/2023 17:15 RACHEL LAFLEUR Active 16 F 11/6/2006 Memorial Clinic
4/28/2023 16:30 RANDY BENOIT Active 57 M 2/26/1966 Willowbrook Clinic
4/28/2023 11:30 RHONDA WADDELL Active 52 F 11/4/1970 Memorial Clinic
4/28/2023 16:00 RILEY WALTHER P+Active 18 M 9/3/2004 Willowbrook Clinic
4/28/2023 9:30 RITA PEREZ Active 58 F 1/23/1965 Memorial Clinic
4/28/2023 10:00 ROBERT MCKETHAN P+Active 37 M 1/15/1986 Willowbrook Clinic
4/28/2023 10:00 ROBIN AGUIRRE Active 26 F 8/10/1996 Memorial Clinic
4/28/2023 15:00 ROCHELLE BUTLER Active 31 F 9/18/1991 Memorial Clinic
4/28/2023 10:15 RUBY SALAZAR Active 31 F 9/26/1991 Willowbrook Clinic
4/28/2023 12:00 RYAN LEE Active 34 M 11/3/1988 Willowbrook Clinic
4/28/2023 9:00 SAMUEL RENDON Active 41 M 6/14/1981 Willowbrook Clinic
4/28/2023 9:45 SELIA RUIZ Active 53 F 10/6/1969 Willowbrook Clinic
4/28/2023 11:45 SETH THOMAS Active 27 M 10/10/1995 Willowbrook Clinic
4/28/2023 12:00 SHYNIKE ALLEN Active 43 F 8/30/1979 Kingwood Clinic
4/28/2023 10:45 SKYLER FRIEDMAN Active 21 F 6/28/2001 Memorial Clinic
4/28/2023 16:45 SOPHIA VILLACORTA Active 15 F 1/25/2008 Memorial Clinic
4/28/2023 11:45 STEPHANIE WARD Active 47 F 10/13/1975 Memorial Clinic
4/28/2023 10:30 THOMAS GROVES Active 42 M 11/27/1980 Willowbrook Clinic
4/28/2023 12:30 TRAVIS PIRTLE P+Active 29 M 8/25/1993 Kingwood Clinic
4/28/2023 13:45 VALENTIN SERRANO Active 40 M 1/21/1983 Willowbrook Clinic
4/28/2023 12:00 VALERIE CERVANTES Active 21 F 8/25/2001 Kingwood Clinic
4/28/2023 11:30 VICTORIA CICERI Active 74 F 2/20/1949 Willowbrook Clinic
4/28/2023 12:00 VICTORIA CLINGER Active 21 F 5/8/2002 Willowbrook Clinic
4/28/2023 16:00 YOLANDA NEGRETE Active 12 F 6/25/2010 Willowbrook Clinic
 Provider Visit Type

OLUWAFERANMI AFOLABI, NP T - New Pt, Outpatient Office Visit

WILLICIA TORAN, NP Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
MASOOD JILANI, MD T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
OLUWAFERANMI AFOLABI, NP T - Est Pt, Outpatient Office Visit
RANDI KATZ, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
RANDI KATZ, NP T - Est Pt, Outpatient Office Visit
RANDI KATZ, NP T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP T - Est Pt, Outpatient Office Visit
OLUWAFERANMI AFOLABI, NP T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - New Pt, Outpatient Office Visit
RANDI KATZ, NP T - Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
MASOOD JILANI, MD New Pt, Outpatient Office Visit
AMANDA RAY, NP Est Pt, Outpatient Office Visit
OLUWAFERANMI AFOLABI, NP T - Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
MASOOD JILANI, MD Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
RANDI KATZ, NP T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP T - Est Pt, Outpatient Office Visit
MASOOD JILANI, MD T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
MASOOD JILANI, MD TMS Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
CASSANDRA BODUCH, MD T - Est Pt, Outpatient Office Visit
MASOOD JILANI, MD Est Pt, Outpatient Office Visit
RANDI KATZ, NP T - New Pt, Outpatient Office Visit
AMANDA RAY, NP T - Est Pt, Outpatient Office Visit
MASOOD JILANI, MD T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
RANDI KATZ, NP T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP T - Est Pt, Outpatient Office Visit
 AMANDA RAY, NP T - Est Pt, Outpatient Office Visit
RANDI KATZ, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Transitional Care Mngt
AMANDA RAY, NP Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
OLUWAFERANMI AFOLABI, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
RANDI KATZ, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
MASOOD JILANI, MD Est Pt, Outpatient Office Visit
AMANDA RAY, NP Est Pt, Outpatient Office Visit
RANDI KATZ, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP T - New Pt, Outpatient Office Visit
TAI JOHNSON, NP New Pt, Outpatient Office Visit
RANDI KATZ, NP T - Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
RANDI KATZ, NP T - New Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
MASOOD JILANI, MD TMS Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP Est Pt, Outpatient Office Visit
AMANDA RAY, NP T - Est Pt, Outpatient Office Visit
RANDI KATZ, NP T - Est Pt, Outpatient Office Visit
OLUWAFERANMI AFOLABI, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP Est Pt, Outpatient Office Visit
MASOOD JILANI, MD New Pt, Outpatient Office Visit
WILLICIA TORAN, NP Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP Est Pt, Outpatient Office Visit
AMANDA RAY, NP Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Transitional Care Mngt
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
OLUWAFERANMI AFOLABI, NP T - New Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
TAI JOHNSON, NP T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP T - Est Pt, Outpatient Office Visit
OLUWAFERANMI AFOLABI, NP T - New Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
RANDI KATZ, NP T - Est Pt, Outpatient Office Visit
MASOOD JILANI, MD T - Est Pt, Outpatient Office Visit
WILLICIA TORAN, NP T - Est Pt, Outpatient Office Visit
AMANDA RAY, NP Est Pt, Outpatient Office Visit
 Primary/Secondary Scheduling Status Status Time Room

BCBS-PPO / Scheduled 4/28/2023 14:26

BCBS-PPO / Checked-Out 4/28/2023 12:56
Cigna-OpenAccess / Checked-Out 4/28/2023 16:07
SuperiorMedicaid / Checked-Out 4/28/2023 17:09
Amerigroup-Medicaid / Select insurance plan Checked-Out 4/28/2023 12:36
BCBS-PPO / Checked-Out 4/28/2023 10:55
Checked-Out 5/1/2023 10:37
Allegieance / Checked-Out 4/28/2023 10:57
SuperiorMedicaid / Checked-Out 4/28/2023 16:53
BCBS-PPO / Checked-Out 4/28/2023 12:48
UHC/Optum / Checked-Out 4/28/2023 16:14
UHC/Optum / SuperiorMedicaid Checked-Out 5/1/2023 9:01
UHC/Optum-Choice / Checked-Out 4/28/2023 16:51
Wellcare-UAR-Commercial / Scheduled 4/28/2023 14:14
SuperiorMedicaid / Checked-Out 4/28/2023 14:34
BCBS-PPO / Checked-Out 4/28/2023 10:11
BCBS-PPO / Checked-Out 4/28/2023 10:01
Amerigroup-Medicaid / Checked-Out 4/28/2023 16:16
BCBS-PPO / Select insurance plan Checked-Out 4/28/2023 16:10
UHC/Optum-ChoicePlus / Select insurance plan Checked-Out 4/28/2023 12:01
UHC/Optum-Choice / Checked-Out 4/28/2023 11:11
MedicareA&B / Checked-Out 4/28/2023 10:02
BCBS-PPO / Checked-Out 5/1/2023 10:11
BCBS-MyBlueHealth / Checked-Out 4/28/2023 10:55
BCBS-PPO / UHC/Optum Checked-Out 4/28/2023 14:36
Cigna-Healthspring / Checked-Out 4/28/2023 11:13
Humana-MedicareHMO / MedicareA&B Checked-Out 4/28/2023 13:43
SuperiorMedicaid / Checked-Out 4/28/2023 14:32
TXChildrenMedicaid / Checked-Out 4/28/2023 14:14
MedicareA&B / Medicare-ManhattanLife Checked-Out 4/28/2023 14:41
Humana-MedicareHMO / Checked-Out 4/28/2023 17:36
CHC-Medicaid / Checked-Out 4/28/2023 16:21
BCBS-BlueAdvantage / Checked-Out 4/28/2023 18:04
UHC/Optum / Checked-Out 4/28/2023 15:45
Cigna-OpenAccess / Checked-Out 5/1/2023 8:47
BCBS-PPO / Select insurance plan Checked-Out 4/28/2023 13:27
Devoted / Checked-Out 4/28/2023 15:33
Ambetter-Marketplace / Checked-Out 4/28/2023 14:29
Ambetter-Marketplace / CHC-Medicaid Checked-Out 4/28/2023 10:43
SuperiorMedicaid / Checked-Out 4/28/2023 17:05
BCBS-PPO / Checked-Out 4/28/2023 10:51
Aetna-PPO / Checked-Out 4/28/2023 14:31
UHC/Optum / Checked-Out 4/28/2023 16:31
 Amerigroup-Medicaid / Checked-Out 4/28/2023 10:31
UHC/Optum / Checked-Out 4/28/2023 16:03
TXChildrenMedicaid / Checked-Out 4/28/2023 15:05
Aetna-PPO / Checked-Out 4/28/2023 14:27
Amerigroup-Medicaid / Checked-Out 4/28/2023 11:25
BCBS-PPO / Checked-Out 4/28/2023 16:10
Wellcare-UXR-Medicaid/Medicare / TexasMedicaid Checked-Out 5/1/2023 10:19
BCBS-PPO / Checked-Out 4/28/2023 15:03
UHC/Optum-Medicaid / Checked-Out 4/28/2023 16:12
TXChildrenMedicaid / Select insurance plan Checked-Out 4/28/2023 14:33
MedicareA&B / Tricare Scheduled 3/31/2023 12:24
Checked-Out 4/28/2023 13:13
CHC-Medicaid / Checked-Out 4/28/2023 16:09
UHC/Optum / Checked-Out 4/28/2023 10:19
CHC-Medicaid / Checked-Out 4/28/2023 10:48
Healthpartners / Select insurance plan Checked-Out 4/28/2023 16:11
Cigna-Healthspring / Checked-Out 5/4/2023 12:02
CHC-Medicaid / Checked-Out 5/1/2023 10:27
UHC/Optum-ChoicePlus / Checked-Out 4/28/2023 16:18
TexasMedicaid / Checked-Out 4/28/2023 16:06
All / Checked-Out 4/28/2023 11:19
Humana-MedicareHMO / Checked-Out 4/28/2023 17:37
Humana-PPO / Checked-Out 4/28/2023 11:39
BCBS-PPO / Checked-Out 4/28/2023 11:35
BCBS-PPO / Checked-Out 4/28/2023 16:33
Aetna-PPO / Checked-Out 5/1/2023 8:54
CHC-Medicaid / Checked-Out 5/1/2023 10:15
Ambetter-Marketplace / Checked-Out 4/28/2023 14:38
BCBS-PPO / Select insurance plan Checked-Out 4/28/2023 14:18
UHC/Optum-Medicare / Checked-Out 4/28/2023 16:28
BCBS-PPO / Checked-In 4/28/2023 10:41
Aetna-PPO / Checked-Out 4/28/2023 16:48
CHC-Medicaid / Checked-Out 4/28/2023 18:02
BCBS-PPO / Checked-Out 4/28/2023 17:01
UHC/Optum-ChoicePlus / Checked-Out 4/28/2023 14:08
Aetna-PPO / Select insurance plan Checked-Out 4/28/2023 16:53
TexasMedicaid / Checked-Out 4/28/2023 10:02
Allegieance / Checked-Out 4/28/2023 16:25
SuperiorMedicaid / Checked-Out 4/28/2023 10:29
BCBS-PPO / Checked-Out 4/28/2023 16:08
BCBS-PPO / Checked-Out 4/28/2023 11:52
BCBS-PPO / Select insurance plan Checked-Out 4/28/2023 13:25
Aetna-PPO / Checked-Out 4/28/2023 10:26
BCBS-PPO / Checked-Out 4/28/2023 11:21
Humana-MedicarePPO / Checked-Out 4/28/2023 12:08
 BCBS-HMO / Checked-Out 5/1/2023 9:16
BCBS-PPO / Checked-Out 4/28/2023 11:20
Aetna-PPO / UHC/Optum-Medicaid Checked-Out 4/28/2023 16:51
CHC-Medicaid / Checked-Out 4/28/2023 14:32
BCBS-HMO / Checked-Out 4/28/2023 11:54
BCBS-POS / Checked-Out 5/1/2023 12:23
BCBS-PPO / Checked-Out 4/28/2023 14:23
BCBS-PPO / Checked-Out 5/1/2023 9:06
UHC/Optum-Medicare / Checked-Out 4/28/2023 14:07
Tricare / Select insurance plan Checked-Out 4/28/2023 13:11
CHC-Medicaid / Checked-Out 4/28/2023 16:37
Apt Veri Copay CoIns Balance Sign
Action Balance in CMD
Due Paid Due Paid Due Paid
Yes $0.00 $0.00 $34.50 $0.00 $35.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $12.00 Signed $12.42
Yes $50.00 $0.00 $0.00 $0.00 $0.00 Signed ($50.00)
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $10.00 $0.00 $0.00 $0.00 $20.00 Signed $0.00
Yes $150.00 $0.00 $0.00 $0.00 $810.00 Signed $660.00
Yes $70.00 $0.00 $0.00 $0.00 $250.00 Signed $110.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $34.50 $0.00 $253.00 Signed $183.81
Yes $10.00 $0.00 $0.00 $0.00 ($20.00) Signed ($30.00)
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $30.00 $0.00 $0.00 $0.00 $0.00 Signed ($30.00)
Yes $25.00 $0.00 $0.00 $0.00 $510.00 Signed $485.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $30.00 $0.00 $0.00 $0.00 $0.00 Signed ($30.00)
Yes $45.00 $0.00 $0.00 $0.00 $90.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $50.00 $0.00 $0.00 $0.00 $0.00 Signed ($50.00)
Yes $40.00 $0.00 $0.00 $0.00 $80.00 Signed $40.00
Pending $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $321.00 Signed $260.68
Yes $20.00 $0.00 $0.00 $0.00 ($20.00) Signed ($60.00)
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 ($30.00) Signed ($30.00)
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Auth Req $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 ($65.00) Signed ($65.20)
Yes $0.00 $0.00 $0.00 $0.00 ($10.00) Signed ($100.00)
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $30.00 $0.00 $0.00 $0.00 $25.00 Signed ($5.00)
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $30.00 $0.00 $0.00 $0.00 $60.00 Signed $0.00
Yes $30.00 $0.00 $0.00 $0.00 $90.00 Signed $60.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $360.00 Signed $360.00
Yes $0.00 $0.00 $0.00 $0.00 $117.00 Signed $116.54
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $30.00 $0.00 $0.00 $0.00 $60.00 Signed $30.00
Yes $60.00 $0.00 $0.00 $0.00 $120.00 Signed $60.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed ($45.00)
 Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $24.08 $0.00 $72.00 Signed $48.16
Auth Req $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $329.00 Signed $214.17
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $22.99 $0.00 $23.00 Signed ($0.04)
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $25.00 $0.00 $0.00 $0.00 $236.00 Signed $210.90
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Auth Req $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Yes $150.00 $0.00 $0.00 $0.00 $745.00 Signed $445.00
Yes $0.00 $0.00 $0.00 $0.00 ($10.00) Signed ($10.00)
Yes $0.00 $0.00 $24.08 $0.00 $688.00 Signed $2,029.29
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Pending $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $30.00 $0.00 $0.00 $0.00 $90.00 Signed $60.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $20.00 $0.00 $0.00 $0.00 ($20.00) Signed ($40.00)
Yes $30.00 $0.00 $0.00 $0.00 $145.00 Signed ($275.00)
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $372.00 Signed $486.76
Yes $25.00 $0.00 $0.00 $0.00 $55.00 Signed ($26.41)
Yes $50.00 $0.00 $0.00 $0.00 $60.00 Signed $10.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $30.00 $0.00 $0.00 $0.00 ($6.00) Signed ($36.00)
Yes $30.00 $0.00 $0.00 $0.00 $150.00 Signed $0.00
Yes $0.00 $0.00 $12.45 $0.00 $406.00 Signed $381.15
Yes $25.00 $0.00 $0.00 $0.00 ($25.00) ($50.00)
Yes $0.00 $0.00 $0.00 $0.00 $93.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $30.00 $0.00 $0.00 $0.00 $90.00 Signed $0.00
Yes $25.00 $0.00 $0.00 $0.00 $25.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Pending $0.00 $0.00 $0.00 $0.00 $348.00 Signed $348.14
Yes $0.00 $0.00 $0.00 $0.00 $110.00 Signed $110.14
Yes $0.00 $0.00 $0.00 $0.00 $345.00 Signed $344.96
Yes $20.00 $0.00 $0.00 $0.00 $40.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $330.00 Signed $330.10
Yes $15.00 $0.00 $0.00 $0.00 $15.00 Signed $0.00
Pending $0.00 $0.00 $0.00 $0.00 $640.00 Signed $640.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $25.00 $25.00 $0.00 $0.00 $25.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $112.00 Signed $112.35
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
Yes $0.00 $0.00 $34.80 $0.00 $35.00 Signed $0.00
Yes $25.00 $0.00 $0.00 $0.00 $558.00 Signed $483.00
Yes $0.00 $0.00 $0.00 $0.00 $465.00 Signed $464.97
Yes $0.00 $0.00 $12.45 $0.00 $12.00 Signed $0.00
Yes $36.00 $0.00 $0.00 $0.00 ($30.00) Signed ($66.00)
Yes $0.00 $0.00 $0.00 $0.00 $0.00 Signed $0.00
 Resource Name Patient ID Appt Facility ID Appt Resource ID
AMANDA RAY 37635769 10254997 10181064
AMANDA RAY 37683163 10254997 10181064
AMANDA RAY 38531580 10254997 10181064
AMANDA RAY 39055015 10254997 10181064
AMANDA RAY 39275150 10254997 10181064
AMANDA RAY 39301655 10254997 10181064
AMANDA RAY 39715750 10254997 10181064
AMANDA RAY 40707842 10254997 10181064
AMANDA RAY 40810087 10254997 10181064
AMANDA RAY 42281521 10254997 10181064
AMANDA RAY 42281567 10254997 10181064
AMANDA RAY 42310142 10254997 10181064
AMANDA RAY 42420763 10254997 10181064
AMANDA RAY 42443490 10254997 10181064
AMANDA RAY 42602656 10254997 10181064
AMANDA RAY 43896521 10254997 10181064
AMANDA RAY 44276627 10254997 10181064
AMANDA RAY 44560701 10254997 10181064
AMANDA RAY 45618807 10254997 10181064
AMANDA RAY 49631926 10254997 10181064
AMANDA RAY 50404785 10254997 10181064
AMANDA RAY 50642140 10254997 10181064
AMANDA RAY 50725371 10254997 10181064
AMANDA RAY 50854086 10254997 10181064
AMANDA RAY 51010732 10254997 10181064
AMANDA RAY 52006008 10254997 10181064
AMANDA RAY 52655334 10254997 10181064
AMANDA RAY 54007632 10254997 10181064
AMANDA RAY 54049003 10254997 10181064
AMANDA RAY 54126972 10254997 10181064
AMANDA RAY Totals
AMY VARGHESE 52667682 10254997 10189435
AMY VARGHESE Totals
ANDREA ANDERSON 54101527 10254997 10189694
ANDREA ANDERSON Totals
CASSANDRA BODUCH 50140424 10254997 10189216
CASSANDRA BODUCH Totals
DR. MASOOD JILANI 47411454 10254997 10189626
DR. MASOOD JILANI 48828097 10254997 10189626
DR. MASOOD JILANI 49511452 10254997 10189626
DR. MASOOD JILANI 49963568 10254997 10189626
DR. MASOOD JILANI 52591442 10254997 10189626
DR. MASOOD JILANI 53297879 10254997 10189626
DR. MASOOD JILANI 53391186 10254997 10189626
 DR. MASOOD JILANI 53581635 10254997 10189626
DR. MASOOD JILANI 53961556 10254997 10189626
DR. MASOOD JILANI 53977728 10254997 10189626
DR. MASOOD JILANI 54201163 10254997 10189626
DR. MASOOD JILANI 54226150 10254997 10189626
DR. MASOOD JILANI Totals
RANDI KATZ 42419997 10254997 10189766
RANDI KATZ 44612692 10254997 10189766
RANDI KATZ 47020912 10254997 10189766
RANDI KATZ 48186248 10254997 10189766
RANDI KATZ 52449231 10254997 10189766
RANDI KATZ 52627323 10254997 10189766
RANDI KATZ 52875557 10254997 10189766
RANDI KATZ 52944078 10254997 10189766
RANDI KATZ 52991045 10254997 10189766
RANDI KATZ 52992547 10254997 10189766
RANDI KATZ 52995612 10254997 10189766
RANDI KATZ 53052307 10254997 10189766
RANDI KATZ 53079383 10254997 10189766
RANDI KATZ 53755588 10254997 10189766
RANDI KATZ 53781299 10254997 10189766
RANDI KATZ 53796638 10254997 10189766
RANDI KATZ 54063527 10254997 10189766
RANDI KATZ 54194799 10254997 10189766
RANDI KATZ 54210831 10254997 10189766
RANDI KATZ 54225585 10254997 10189766
RANDI KATZ 54232269 10254997 10189766
RANDI KATZ Totals
TAI JOHNSON, NP 40861554 10254997 10189991
TAI JOHNSON, NP 41716833 10254997 10189991
TAI JOHNSON, NP 42613598 10254997 10189991
TAI JOHNSON, NP 45598325 10254997 10189991
TAI JOHNSON, NP 47883792 10254997 10189991
TAI JOHNSON, NP 49117090 10254997 10189991
TAI JOHNSON, NP 49614662 10254997 10189991
TAI JOHNSON, NP 50300905 10254997 10189991
TAI JOHNSON, NP 50587832 10254997 10189991
TAI JOHNSON, NP 50592178 10254997 10189991
TAI JOHNSON, NP 50614473 10254997 10189991
TAI JOHNSON, NP 50657205 10254997 10189991
TAI JOHNSON, NP 50671117 10254997 10189991
TAI JOHNSON, NP 50918030 10254997 10189991
TAI JOHNSON, NP 51193099 10254997 10189991
TAI JOHNSON, NP 51371683 10254997 10189991
TAI JOHNSON, NP 51480647 10254997 10189991
 TAI JOHNSON, NP 51574671 10254997 10189991
TAI JOHNSON, NP 51926677 10254997 10189991
TAI JOHNSON, NP 52008229 10254997 10189991
TAI JOHNSON, NP 52037730 10254997 10189991
TAI JOHNSON, NP 53076338 10254997 10189991
TAI JOHNSON, NP 53342772 10254997 10189991
TAI JOHNSON, NP 53735538 10254997 10189991
TAI JOHNSON, NP 53765729 10254997 10189991
TAI JOHNSON, NP 53892098 10254997 10189991
TAI JOHNSON, NP 53904959 10254997 10189991
TAI JOHNSON, NP 54002789 10254997 10189991
TAI JOHNSON, NP 54005707 10254997 10189991
TAI JOHNSON, NP 54034466 10254997 10189991
TAI JOHNSON, NP 54053462 10254997 10189991
TAI JOHNSON, NP 54091988 10254997 10189991
TAI JOHNSON, NP 54199537 10254997 10189991
TAI JOHNSON, NP 54200438 10254997 10189991
TAI JOHNSON, NP 54200532 10254997 10189991
TAI JOHNSON, NP 54209482 10254997 10189991
TAI JOHNSON, NP 54236049 10254997 10189991
TAI JOHNSON, NP 54239027 10254997 10189991
TAI JOHNSON, NP Totals
WILLICIA TORAN 37699446 10254997 10189767
WILLICIA TORAN 41606218 10254997 10189767
WILLICIA TORAN 41690156 10254997 10189767
WILLICIA TORAN 42470153 10254997 10189767
WILLICIA TORAN 42633823 10254997 10189767
WILLICIA TORAN 46857518 10254997 10189767
WILLICIA TORAN 48277684 10254997 10189767
WILLICIA TORAN 49779313 10254997 10189767
WILLICIA TORAN 50191552 10254997 10189767
WILLICIA TORAN 50310756 10254997 10189767
WILLICIA TORAN 50356440 10254997 10189767
WILLICIA TORAN 51389474 10254997 10189767
WILLICIA TORAN 51694419 10254997 10189767
WILLICIA TORAN 52815830 10254997 10189767
WILLICIA TORAN 52876110 10254997 10189767
WILLICIA TORAN 53055925 10254997 10189767
WILLICIA TORAN 53066514 10254997 10189767
WILLICIA TORAN 53174375 10254997 10189767
WILLICIA TORAN 53219373 10254997 10189767
WILLICIA TORAN 53329575 10254997 10189767
WILLICIA TORAN 53394883 10254997 10189767
WILLICIA TORAN 53647709 10254997 10189767
WILLICIA TORAN 53649282 10254997 10189767
 WILLICIA TORAN 53649527 10254997 10189767
WILLICIA TORAN 53712513 10254997 10189767
WILLICIA TORAN 54005239 10254997 10189767
WILLICIA TORAN 54007522 10254997 10189767
WILLICIA TORAN 54019498 10254997 10189767
WILLICIA TORAN 54185800 10254997 10189767
WILLICIA TORAN Totals
 Resource Name Appointment Date Appointment Date Patient First Name
AMANDA RAY 04/28/2023 Apr 2023 PATRICIA
AMANDA RAY 04/28/2023 Apr 2023 PABLO
AMANDA RAY 04/28/2023 Apr 2023 JASON
AMANDA RAY 04/28/2023 Apr 2023 THOMAS
AMANDA RAY 04/28/2023 Apr 2023 CARMELLA
AMANDA RAY 04/28/2023 Apr 2023 NATHAN
AMANDA RAY 04/28/2023 Apr 2023 JAYCIE
AMANDA RAY 04/28/2023 Apr 2023 CAMERON
AMANDA RAY 04/28/2023 Apr 2023 ASHLEY
AMANDA RAY 04/28/2023 Apr 2023 DESIRE
AMANDA RAY 04/28/2023 Apr 2023 CHELSEA
AMANDA RAY 04/28/2023 Apr 2023 KIMM
AMANDA RAY 04/28/2023 Apr 2023 YOLANDA
AMANDA RAY 04/28/2023 Apr 2023 BRIAN
AMANDA RAY 04/28/2023 Apr 2023 JOHNNY
AMANDA RAY 04/28/2023 Apr 2023 JAMIE
AMANDA RAY 04/28/2023 Apr 2023 RITA
AMANDA RAY 04/28/2023 Apr 2023 DAMEON
AMANDA RAY 04/28/2023 Apr 2023 CHRISTINA
AMANDA RAY 04/28/2023 Apr 2023 JUSTIN
AMANDA RAY 04/28/2023 Apr 2023 HOLLY
AMANDA RAY 04/28/2023 Apr 2023 JOHANNES
AMANDA RAY 04/28/2023 Apr 2023 JILLIAN
AMANDA RAY 04/28/2023 Apr 2023 SAMUEL
AMANDA RAY 04/28/2023 Apr 2023 TRACIE
AMANDA RAY 04/28/2023 Apr 2023 JISELLE
AMANDA RAY 04/28/2023 Apr 2023 JESSICA
AMANDA RAY 04/28/2023 Apr 2023 RYAN
AMANDA RAY 04/28/2023 Apr 2023 ROBERT
AMANDA RAY 04/28/2023 Apr 2023 MARY

AMY VARGHESE 04/28/2023 Apr 2023 VICTORIA

ANDREA ANDERSON 04/28/2023 Apr 2023 JOSE

CASSANDRA BODUCH 04/28/2023 Apr 2023 GUADALUPE

DR. MASOOD JILANI 04/28/2023 Apr 2023 DARIN

DR. MASOOD JILANI 04/28/2023 Apr 2023 GINA
DR. MASOOD JILANI 04/28/2023 Apr 2023 AMANDA
DR. MASOOD JILANI 04/28/2023 Apr 2023 MIGUEL
DR. MASOOD JILANI 04/28/2023 Apr 2023 IISHIA
DR. MASOOD JILANI 04/28/2023 Apr 2023 KENNETH
DR. MASOOD JILANI 04/28/2023 Apr 2023 VICTORIA
DR. MASOOD JILANI 04/28/2023 Apr 2023 PATRICK
DR. MASOOD JILANI 04/28/2023 Apr 2023 ERICA
DR. MASOOD JILANI 04/28/2023 Apr 2023 GUADALUPE
DR. MASOOD JILANI 04/28/2023 Apr 2023 PEDRO J
DR. MASOOD JILANI 04/28/2023 Apr 2023 CYNTHIA

RANDI KATZ 04/28/2023 Apr 2023 KWANITA

RANDI KATZ 04/28/2023 Apr 2023 DENISE
RANDI KATZ 04/28/2023 Apr 2023 HUNTER
RANDI KATZ 04/28/2023 Apr 2023 NATHANIEL
RANDI KATZ 04/28/2023 Apr 2023 CLEO
RANDI KATZ 04/28/2023 Apr 2023 JOSE
RANDI KATZ 04/28/2023 Apr 2023 VALERIE
RANDI KATZ 04/28/2023 Apr 2023 RICKY
RANDI KATZ 04/28/2023 Apr 2023 ATIYA
RANDI KATZ 04/28/2023 Apr 2023 BARBARA
RANDI KATZ 04/28/2023 Apr 2023 BEVERLY
RANDI KATZ 04/28/2023 Apr 2023 MELANIE
RANDI KATZ 04/28/2023 Apr 2023 ANDREW
RANDI KATZ 04/28/2023 Apr 2023 KAYLA
RANDI KATZ 04/28/2023 Apr 2023 JENNIFER
RANDI KATZ 04/28/2023 Apr 2023 KRISTINA
RANDI KATZ 04/28/2023 Apr 2023 HAILEE
RANDI KATZ 04/28/2023 Apr 2023 MISTY
RANDI KATZ 04/28/2023 Apr 2023 LAYLA
RANDI KATZ 04/28/2023 Apr 2023 MICHELLE
RANDI KATZ 04/28/2023 Apr 2023 JULIUS

TAI JOHNSON, NP 04/28/2023 Apr 2023 MYRNA

TAI JOHNSON, NP 04/28/2023 Apr 2023 ARSHAUNA
TAI JOHNSON, NP 04/28/2023 Apr 2023 CAROLYN
TAI JOHNSON, NP 04/28/2023 Apr 2023 KAY
TAI JOHNSON, NP 04/28/2023 Apr 2023 GAIL
TAI JOHNSON, NP 04/28/2023 Apr 2023 RHONDA
TAI JOHNSON, NP 04/28/2023 Apr 2023 AMY
TAI JOHNSON, NP 04/28/2023 Apr 2023 BEVERLY
TAI JOHNSON, NP 04/28/2023 Apr 2023 SKYLER
TAI JOHNSON, NP 04/28/2023 Apr 2023 DANA
TAI JOHNSON, NP 04/28/2023 Apr 2023 ANGELINA
TAI JOHNSON, NP 04/28/2023 Apr 2023 ALIYAH
TAI JOHNSON, NP 04/28/2023 Apr 2023 JAVIAN
TAI JOHNSON, NP 04/28/2023 Apr 2023 STANDRIC
TAI JOHNSON, NP 04/28/2023 Apr 2023 CHRISTOPHER
TAI JOHNSON, NP 04/28/2023 Apr 2023 STEPHANIE
TAI JOHNSON, NP 04/28/2023 Apr 2023 RACHEL
TAI JOHNSON, NP 04/28/2023 Apr 2023 OMAR
TAI JOHNSON, NP 04/28/2023 Apr 2023 ALAA
TAI JOHNSON, NP 04/28/2023 Apr 2023 SOPHIA
TAI JOHNSON, NP 04/28/2023 Apr 2023 KAMDYN
TAI JOHNSON, NP 04/28/2023 Apr 2023 AMBER
TAI JOHNSON, NP 04/28/2023 Apr 2023 OMENA
TAI JOHNSON, NP 04/28/2023 Apr 2023 LAWANDA
TAI JOHNSON, NP 04/28/2023 Apr 2023 ROBIN
TAI JOHNSON, NP 04/28/2023 Apr 2023 JOSELYN
TAI JOHNSON, NP 04/28/2023 Apr 2023 KAYLA
TAI JOHNSON, NP 04/28/2023 Apr 2023 RITA
TAI JOHNSON, NP 04/28/2023 Apr 2023 SHARON
TAI JOHNSON, NP 04/28/2023 Apr 2023 KENDRICK
TAI JOHNSON, NP 04/28/2023 Apr 2023 ALEXIS
TAI JOHNSON, NP 04/28/2023 Apr 2023 DEORNELL
TAI JOHNSON, NP 04/28/2023 Apr 2023 GREGORY
TAI JOHNSON, NP 04/28/2023 Apr 2023 SHYNIKE
TAI JOHNSON, NP 04/28/2023 Apr 2023 MAVIS
TAI JOHNSON, NP 04/28/2023 Apr 2023 ROCHELLE
TAI JOHNSON, NP 04/28/2023 Apr 2023 TRAVIS
TAI JOHNSON, NP 04/28/2023 Apr 2023 AARON

WILLICIA TORAN 04/28/2023 Apr 2023 HOLLY

WILLICIA TORAN 04/28/2023 Apr 2023 RUBY
WILLICIA TORAN 04/28/2023 Apr 2023 DANIELLE
WILLICIA TORAN 04/28/2023 Apr 2023 JENNIFER
WILLICIA TORAN 04/28/2023 Apr 2023 SELIA
WILLICIA TORAN 04/28/2023 Apr 2023 MARCUS
WILLICIA TORAN 04/28/2023 Apr 2023 SETH
WILLICIA TORAN 04/28/2023 Apr 2023 PEDRO
WILLICIA TORAN 04/28/2023 Apr 2023 MEREDITH
WILLICIA TORAN 04/28/2023 Apr 2023 VICTORIA
WILLICIA TORAN 04/28/2023 Apr 2023 MICHELLE
WILLICIA TORAN 04/28/2023 Apr 2023 ADRIANA
WILLICIA TORAN 04/28/2023 Apr 2023 APEARL
WILLICIA TORAN 04/28/2023 Apr 2023 JOHN
WILLICIA TORAN 04/28/2023 Apr 2023 GIZZA
WILLICIA TORAN 04/28/2023 Apr 2023 CHRISTOPHER
WILLICIA TORAN 04/28/2023 Apr 2023 RANDY
WILLICIA TORAN 04/28/2023 Apr 2023 OPE
WILLICIA TORAN 04/28/2023 Apr 2023 CONNOR
WILLICIA TORAN 04/28/2023 Apr 2023 VALENTIN
WILLICIA TORAN 04/28/2023 Apr 2023 NANCY
WILLICIA TORAN 04/28/2023 Apr 2023 RILEY
WILLICIA TORAN 04/28/2023 Apr 2023 DEBORAH
WILLICIA TORAN 04/28/2023 Apr 2023 BRIANA
WILLICIA TORAN 04/28/2023 Apr 2023 ASHLEY
WILLICIA TORAN 04/28/2023 Apr 2023 MAKAYLA
WILLICIA TORAN 04/28/2023 Apr 2023 JANASIA
WILLICIA TORAN 04/28/2023 Apr 2023 JUSTYCE
WILLICIA TORAN 04/28/2023 Apr 2023 BRENDA
Patient Last Name Patient Full Name Patient Birthday Appt Status
CRUZ CRUZ, PATRICIA A 11/07/1950 Checked-Out
PEREZ PEREZ, PABLO A 04/18/2011 No Show
KRETZSCHMAR KRETZSCHMAR, JASON 11/10/1976 Checked-Out
GROVES GROVES, THOMAS R 11/27/1980 Checked-Out
NIELSEN NIELSEN, CARMELLA 07/31/1973 Checked-Out
THOMPSON THOMPSON, NATHAN 07/21/2006 Checked-Out
BECKER BECKER, JAYCIE L 03/21/2016 No Show
GWINN GWINN, CAMERON 01/29/2003 No Show
POWERS POWERS, ASHLEY G 03/29/1992 No Show
REYNOLDS REYNOLDS, DESIRE 12/07/2011 Checked-Out
RILES RILES, CHELSEA 07/06/2014 Checked-Out
BRYSON BRYSON, KIMM 06/01/1983 Checked-Out
NEGRETE NEGRETE, YOLANDA J 06/25/2010 Checked-Out
WILSON WILSON, BRIAN 04/25/1983 No Show
DIAZ DIAZ, JOHNNY A 02/14/1989 Checked-Out
ROWE ROWE, JAMIE 10/16/1985 Checked-Out
RHODES RHODES, RITA 08/11/1967 No Show
RANDALL DENNIS RANDALL DENNIS, DAMEON D 06/25/1977 Checked-Out
SMITH SMITH, CHRISTINA R 03/21/1980 Checked-Out
WILLIAMS WILLIAMS, JUSTIN 09/13/2000 Checked-Out
ROOS ROOS, HOLLY 06/17/1991 Checked-Out
SANCERNI SANCERNI, JOHANNES 01/02/2008 Checked-Out
BECKER BECKER, JILLIAN L 05/19/2015 No Show
RENDON RENDON, SAMUEL H 06/14/1981 Checked-Out
COX COX, TRACIE L 08/16/1970 No Show
CASTILLO CASTILLO, JISELLE 08/12/1995 Canceled
BECKER BECKER, JESSICA L 08/22/1985 Checked-Out
LEE LEE, RYAN COY 11/03/1988 Checked-Out
MCKETHAN MCKETHAN, ROBERT ALEXANDER 01/15/1986 Checked-Out
MONTOYA MONTOYA, MARY 10/04/1989 Checked-Out
30
JACKSON JACKSON, VICTORIA 02/21/1983 Canceled
1
VELASQUEZ VELASQUEZ, JOSE 12/02/1959 ins Verified
1
MUNOZ ARANHA MUNOZ ARANHA, GUADALUPE M 03/07/1966 Checked-Out
1
THOMPSON THOMPSON, DARIN A 08/29/1997 Checked-Out
RAMSEY RAMSEY, GINA G 11/11/1964 Checked-Out
ERP ERP, AMANDA L 11/20/1992 Checked-Out
VARELA VARELA, MIGUEL O 09/05/1958 Checked-Out
SINER SINER, IISHIA D 09/13/1977 Checked-Out
CATLETT CATLETT, KENNETH E 12/24/1949 ins Verified
CICERI CICERI, VICTORIA 02/20/1949 Checked-Out
 FARALDO FARALDO, PATRICK 08/26/1998 Rescheduled
VAN RIPER VAN RIPER, ERICA N 04/12/1989 Checked-Out
ZAMUDIO ZAMUDIO, GUADALUPE 02/20/1940 Checked-Out
VIVES VIVES, PEDRO J 05/01/1952 Checked-In
ORJI ORJI, CYNTHIA C 02/07/1986 Checked-Out
12
FIELDS FIELDS, KWANITA 05/07/2000 Checked-Out
CHASTUN CHASTUN, DENISE 10/25/1959 Checked-Out
GALLIANO GALLIANO, HUNTER 06/23/2003 No Show
BARKER BARKER, NATHANIEL 06/04/1962 Checked-Out
LEWIS-RASH LEWIS-RASH, CLEO 11/11/1995 Checked-Out
MENDOZA MENDOZA, JOSE B 05/27/1994 Checked-Out
CERVANTES CERVANTES, VALERIE J 08/25/2001 Checked-Out
STORY STORY, RICKY M 04/21/1993 No Show
POINDEXTER POINDEXTER, ATIYA 08/10/1981 Checked-Out
GARDNER GARDNER, BARBARA 04/26/1962 Canceled
GRANIER GRANIER, BEVERLY I 06/29/1973 Checked-Out
BAUTISTA ORGANIZ BAUTISTA ORGANIZ, MELANIE 09/17/2002 Checked-Out
CORNWELL CORNWELL, ANDREW 05/05/1999 Checked-Out
JACKSON JACKSON, KAYLA A 04/12/1993 Checked-Out
ESCOBAR ESCOBAR, JENNIFER NICOLE 10/23/1982 Checked-Out
TATOM TATOM, KRISTINA K 02/10/1980 No Show
LANCON LANCON, HAILEE 05/11/1993 Checked-Out
HESTER HESTER, MISTY T 04/28/1973 No Show
MOYE MOYE, LAYLA 05/03/2010 Rescheduled
ELLIS ELLIS, MICHELLE 10/10/1981 Checked-Out
SHAW SHAW, JULIUS 04/08/1987 No Show
21
FLORES FLORES, MYRNA 03/16/1953 Checked-Out
TAYLOR TAYLOR, ARSHAUNA 10/31/1989 No Show
TIDWELL TIDWELL, CAROLYN 09/18/1965 Rescheduled
ROWE ROWE, KAY K 02/02/1963 ins Verified
MARTIN MARTIN, GAIL 05/01/1958 Checked-Out
WADDELL WADDELL, RHONDA L 11/04/1970 Checked-Out
WOODS WOODS, AMY 04/01/1993 ins Verified
MARTIN MARTIN, BEVERLY 12/28/1961 No Show
FRIEDMAN FRIEDMAN, SKYLER M 06/28/2001 Checked-Out
FERRERO D'AMBROSI FERRERO D'AMBROSI, DANA 12/15/2008 ins Verified
RUBIO RUBIO, ANGELINA 12/10/2010 Checked-Out
COVARRUBIAS COVARRUBIAS, ALIYAH 08/03/2014 Checked-Out
RUBIO RUBIO, JAVIAN 10/04/2013 Checked-Out
CHOICE CHOICE, STANDRIC 11/28/1972 Rescheduled
DEGGS DEGGS, CHRISTOPHER 04/10/1991 Checked-Out
WARD WARD, STEPHANIE 10/13/1975 Checked-Out
LAFLEUR LAFLEUR, RACHEL 11/06/2006 Checked-Out
 MOHAMED MOHAMED, OMAR 09/11/2006 ins Verified
BAHJAT BAHJAT, ALAA N 04/08/1984 Checked-Out
VILLACORTA VILLACORTA, SOPHIA L 01/25/2008 Checked-Out
ZOZULYA ZOZULYA, KAMDYN N 08/02/2007 Checked-Out
HOSEA HOSEA, AMBER M 10/18/1980 Checked-Out
LUMBI LUMBI, OMENA KABIBI 03/12/1998 Checked-Out
BARNETT BARNETT, LAWANDA J 10/10/1958 Checked-Out
AGUIRRE AGUIRRE, ROBIN 08/10/1996 Checked-Out
GOMEZ GOMEZ, JOSELYN 07/06/2007 Checked-Out
FULLER FULLER, KAYLA 07/22/1998 Checked-Out
PEREZ PEREZ, RITA 01/23/1965 Checked-Out
MCLEMORE MCLEMORE, SHARON ROSS 07/31/1965 No Show
HOUSE HOUSE, KENDRICK 02/09/2009 Checked-Out
CRIADO CRIADO, ALEXIS 01/18/1993 Rescheduled
MARSHALL MARSHALL, DEORNELL 02/17/1967 Rescheduled
JACK JACK, GREGORY 06/30/1970 No Show
ALLEN ALLEN, SHYNIKE 08/30/1979 Rescheduled
TYLER TYLER, MAVIS 12/25/1987 ins Verified
BUTLER BUTLER, ROCHELLE 09/18/1991 Checked-Out
PIRTLE PIRTLE, TRAVIS 08/25/1993 ins Verified
PAULSEY PAULSEY, AARON ANTHONY 03/04/1988 ins Verified
38
SCHAUMLEFFEL SCHAUMLEFFEL, HOLLY B 02/09/1988 No Show
SALAZAR SALAZAR, RUBY J 09/26/1991 Checked-Out
MONTES DE OCA MONTES DE OCA, DANIELLE 02/20/1985 Checked-Out
ABERNATHY ABERNATHY, JENNIFER 03/19/1985 No Show
RUIZ RUIZ, SELIA 10/06/1969 Checked-Out
MARTIN MARTIN, MARCUS 11/29/2001 Checked-Out
THOMAS THOMAS, SETH J 10/10/1995 Checked-Out
LOREDO JR LOREDO JR, PEDRO P 01/11/1987 Checked-Out
CLARK CLARK, MEREDITH A 12/21/2001 Checked-Out
CLINGER CLINGER, VICTORIA 05/08/2002 Checked-Out
SISSON SISSON, MICHELLE 11/07/1970 Checked-Out
RAMIREZ RAMIREZ, ADRIANA 10/12/1995 Checked-Out
SMITH SMITH, APEARL M 12/05/2005 No Show
BENAVIDES BENAVIDES, JOHN A 03/22/1993 No Show
SANTOS SANTOS, GIZZA JANET 07/02/1999 Checked-Out
PENDER PENDER, CHRISTOPHER DAVID 03/24/1978 Checked-Out
BENOIT BENOIT, RANDY L 02/26/1966 Checked-Out
AKINBIYI AKINBIYI, OPE 09/10/1989 Checked-Out
MARTIN MARTIN, CONNOR 07/20/2010 Checked-Out
SERRANO SERRANO, VALENTIN 01/21/1983 Checked-Out
FOYTLIN FOYTLIN, NANCY 03/18/1959 Checked-Out
WALTHER WALTHER, RILEY KEEGAN 09/03/2004 Checked-Out
CHAPMAN CHAPMAN, DEBORAH K 03/24/1956 Checked-Out
 EVANS EVANS, BRIANA 10/08/1990 No Show
YOUNG YOUNG, ASHLEY 01/11/1984 Checked-Out
MANZANARES MANZANARES, MAKAYLA 10/29/2004 No Show
MASSIE MASSIE, JANASIA 03/02/2011 No Show
KING KING, JUSTYCE L 06/10/2003 Checked-Out
PEREZ PEREZ, BRENDA 12/11/2002 No Show
29
133
 Pat. Primary Payer Name Primary Member ID
UNITED HEALTHCARE MEDICARE 902546290
COMMUNITY HEALTH CHOICE MEDICAID 608037773
AMBETTER 463417949
BCBS MAGELLAN 925899597EP
UNITED HEALTHCARE 944223846
BLUE CROSS MEDICARE ADVANTAGE FDP201197528
UNITED HEALTHCARE MEDICAID 710785672
SELF PAY 9999999
BLUE CROSS MEDICARE ADVANTAGE T2U830098597
SUPERIOR HEALTH 611153221
SUPERIOR HEALTH 700774285
SELF PAY 456-63-0067
COMMUNITY HEALTH CHOICE MEDICAID 530750502
COMMUNITY HEALTH MARKETPLACE 000453955900
AMERIGROUP 729919469
AMBETTER U9517027501
CIGNA 919191073554
TEXAS MEDICARE 4CW1T89WV22
BLUE CROSS MEDICARE ADVANTAGE ZGP829982055
AETNA W195350920
BLUE CROSS MEDICARE ADVANTAGE ZGP900606933
MEMORIAL HERMANN 915085422
UNITED HEALTHCARE 705717631
AETNA W253048728
CIGNA U0449046601
AETNA W278686922
AETNA W278594552
BLUE CROSS MEDICARE ADVANTAGE ZGP924246423
CIGNA 919191026958
BLUE CROSS AND BLUE SHIELD OF TEXAS PWD808747163

UNITED HEALTHCARE 983030111

RIVER OAKS HOSPITAL 999999999

BLUE CROSS AND BLUE SHIELD OF TEXAS T2U828357666

BLUE CROSS AND BLUE SHIELD OF TEXAS ZGPR58106650

HUMANA H44398229
AMERIGROUP 732092706
HUMANA H40393774
MAGELLAN BEHAVIORAL HEALTH DHPD9RESK
TEXAS MEDICARE 4VK9GF9UP10
UNITED HEALTHCARE 941754979
 BLUE CROSS AND BLUE SHIELD OF TEXAS M2R826433726
TEXAS CHILDRENS HEALTH PLAN 528615039
UNITED HEALTHCARE 114045158
BLUE CROSS AND BLUE SHIELD OF TEXAS R59092320
UNITED HEALTHCARE 095681935

COMMUNITY HEALTH CHOICE MEDICAID 521640386

HUMANA H01234811
AETNA W018287211
AETNA W251186334
BLUE CROSS MEDICARE ADVANTAGE ZGP824485660
OPTUM BEHAVIORAL HEALTH 212809750
BLUE CROSS MEDICARE ADVANTAGE V6SAN9071485
TEXAS MEDICARE 7UX1N06NX95
OPTUM BEHAVIORAL HEALTH N32638761
CIGNA 779721191322
UNITED HEALTHCARE 974090449
COMMUNITY HEALTH CHOICE MEDICAID 522364796
ALLEGIANCE BENEFIT PLAN MANAGEMENT INC. 779536060322
UNITED HEALTHCARE 527558238
BLUE CROSS MEDICARE ADVANTAGE P2T823845620
AMERIGROUP 719512863
CIGNA U6985677201
CIGNA 35884410
ALLEGIANCE BENEFIT PLAN MANAGEMENT INC. 779536811322
TEXAS MEDICAID 523642955

HUMANA H60218206
WELLCARE TEXAN PLUS 35069757
WELLCARE TEXAN PLUS 30162091
WELLCARE TEXAN PLUS 35423030
TEXAS MEDICARE 9H46MT5VG78
OPTUM BEHAVIORAL HEALTH 994531661
SELF PAY 999999999
MAGELLAN BEHAVIORAL HEALTH DJH343
BLUE CROSS MEDICARE ADVANTAGE ZGP821854640
COMPSYCH 13150695
SUPERIOR HEALTH 531167545
SUPERIOR HEALTH 701265359
SUPERIOR HEALTH 623996360
SELF PAY 9999999
BLUE CROSS MEDICARE ADVANTAGE DOM014W12415
COMMUNITY HEALTH CHOICE MEDICAID 515423707
COMMUNITY HEALTH CHOICE MEDICAID 713777437
COMMUNITY HEALTH CHOICE MEDICAID 731727487
CIGNA U5977535502
AETNA W201156772
BLUE CROSS MEDICARE ADVANTAGE TDP087W09052
BLUE CROSS MEDICARE ADVANTAGE RDU10404827400
AMBETTER U9375187601
UNITED HEALTHCARE 847944136
BLUE CROSS MEDICARE ADVANTAGE BKK827067211
TEXAS CHILDRENS HEALTH PLAN 528174943
BLUE CROSS AND BLUE SHIELD OF TEXAS L5C828693883
TEXAS MEDICAID 243691005
HUMANA H43577118
Texas Children s Health Plan 602866737
AMBETTER-VALUE U9613644501
CIGNA U0422838702
UNITED HEALTHCARE MEDICAID 529659545
BLUE CROSS MEDICARE ADVANTAGE ZGN925137205
CIGNA U7971554801
BLUE CROSS AND BLUE SHIELD OF TEXAS WHM21309234W00
ANTHEM INSURANCE COMPANIES, INC. KHI221W01852
BLUE CROSS AND BLUE SHIELD OF TEXAS ZGP832916652

BLUE CROSS MEDICARE ADVANTAGE ZGP824490654

BLUE CROSS MEDICARE ADVANTAGE SWU685W06767
BLUE CROSS MEDICARE ADVANTAGE ZGP827194649
COMMUNITY HEALTH CHOICE MEDICAID 530638876
BLUE CROSS AND BLUE SHIELD OF TEXAS HEB831360426
COMMUNITY HEALTH CHOICE MEDICAID 521453191
HUMANA 116050931
AETNA 0193932357
UNITED HEALTHCARE 819569778
TRICARE EAST 00573703900
GROUP AND PENSION ADMINISTRATORS 960701282
BLUE CROSS MEDICARE ADVANTAGE T2U805525812
AMERIGROUP 712898147
CIGNA U6387694501
COMMUNITY HEALTH CHOICE MEDICAID 520924758
AMERIGROUP 718622342
BLUE CROSS MEDICARE ADVANTAGE ZTQ841A70861
BLUE CROSS MEDICARE ADVANTAGE UTS0BF6KF5RN
UNITED HEALTHCARE 977118131
BLUE CROSS MEDICARE ADVANTAGE SZE830755896
BLUE CROSS MEDICARE ADVANTAGE T3X831616305
AETNA 758804067
HEALTHSPRING 36506106
BLUE CROSS MEDICARE ADVANTAGE ZGP903309602
BLUE CROSS MEDICARE ADVANTAGE ZGP832916652
UNITED HEALTHCARE 985283206
AMERIGROUP MEDICAID 715374730
AMERIGROUP 715056234
AMBETTER-VALUE U9352312902
 Pat. Secondary Payer Name Secondary Member ID Patient Credits
$12.45
$0.00
COMMUNITY HEALTH CHOICE MEDICAID 706649923 $0.00
$0.00
$30.00
$95.75
$0.00
$0.00
$0.00
$0.00
$0.00
$420.00
$0.00
$80.00
$0.00
$0.00
$0.00
$83.66
$60.00
$0.00
$0.00
$45.00
$0.00
$0.00
$50.00
$0.00
$0.00
$0.00
$0.00
COMMUNITY HEALTH CHOICE MEDICAID 611938572 $0.00

$70.00

$0.00

$60.00

UNITED HEALTHCARE MEDICAID 614111560 $30.00

$160.00
$0.00
$395.00
$0.00
TRICARE EAST 00447228100 $0.00
$0.00
 $40.15
$0.00
$0.00
$50.00
$0.00

$10.00
$0.00
UNITED HEALTHCARE MEDICAID 717012367 $0.00
$0.00
$50.00
$98.98
$0.00
$0.00
$130.00
$30.00
TEXAS MEDICAID 520237133 $0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

$0.00
UNITED HEALTHCARE COMMUNITY PLAN 509644973 $0.00
$0.00
TEXAS MEDICAID 610841211 $0.00
MANHATTAN NATIONAL LIFE INSURANCE 2043400577 $65.20
$0.00
$0.00
$0.00
$0.00
$80.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
 $0.00
$50.00
UNITED HEALTHCARE 528258043 $0.00
$23.03
$0.00
$36.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

$0.00
$0.01
$0.00
$0.00
$15.00
$0.00
$0.00
$92.86
$0.00
$66.00
$80.00
$47.58
$0.00
$35.00
$0.00
$0.00
$0.00
$0.00
$0.00
$50.00
$0.00
$0.00
$0.00
$0.00
$34.50
$0.00
$0.00
$0.00
$0.00
Patient Ins Credits Patient Balance Patient Ins. Balance Last Eligibility Check
$0.00 $381.15 $0.00 04/27/2023
$0.00 $0.00 $0.00 05/08/2023
$0.00 $116.54 $30.00 04/27/2023
$331.32 $0.00 -$331.32 03/30/2023
$0.00 -$30.00 $0.00 04/27/2023
$0.00 -$26.41 $0.00 04/27/2023
$0.00 $30.00 $0.00 04/27/2023
$0.00 $990.00 $0.00 03/31/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 $0.00 $650.00 04/27/2023
$0.00 $0.00 $650.00 04/27/2023
$0.00 $445.00 $0.00
$0.00 $0.00 $0.00 04/27/2023
$99.00 -$80.00 $868.00 03/30/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 $360.00 $0.00 04/27/2023
$0.00 $0.00 $642.00 04/27/2023
$0.00 $260.68 $0.00 04/27/2023
$0.00 -$30.00 $0.00 04/27/2023
$0.00 $214.17 $0.00 05/10/2023
$0.00 $60.00 $0.00 04/27/2023
$0.00 -$45.00 $1,284.00 04/27/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 $330.10 $0.00 04/28/2023
$0.00 $50.00 $0.00 05/08/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 $60.00 $0.00 04/27/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 $0.00 $1,480.00 05/02/2023
$0.00 $0.00 $0.00 05/02/2023

$0.00 -$70.00 $0.00 05/09/2023

$0.00 $0.00 $0.00

$0.00 -$5.00 $784.00 05/10/2023

$0.00 -$30.00 $0.00 05/10/2023

$0.00 -$100.00 $15,422.00 05/10/2023
$0.00 $0.00 $642.00 04/27/2023
$0.00 -$275.00 $14,780.00 05/04/2023
$0.00 $0.00 $0.00 04/10/2023
$0.00 $0.00 $0.00 05/02/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 -$40.15 $0.00 05/04/2023
$0.00 $0.00 $2,122.00 04/27/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 -$50.00 $0.00 05/10/2023
$0.00 $0.00 $0.00 05/10/2023

$0.00 -$10.00 $642.00 05/10/2023

$0.00 $0.00 $0.00 04/27/2023
$0.00 $0.00 $3,449.00 05/03/2023
$0.00 $10.00 $0.00 04/27/2023
$0.00 -$50.00 $0.00 04/27/2023
$0.00 $48.16 $0.00 04/28/2023
$0.00 $464.97 $0.00 04/27/2023
$0.00 $126.28 $40.42 05/08/2023
$0.00 -$30.00 $0.00 04/27/2023
$0.00 -$30.00 $642.00 05/04/2023
$0.00 $0.00 $3,118.00 05/02/2023
$0.00 $0.00 $642.00 04/27/2023
$0.00 $110.00 $642.00 04/27/2023
$0.00 $0.00 $0.00 05/10/2023
$0.00 $30.00 $0.00 04/27/2023
$0.00 $0.00 $642.00 05/05/2023
$0.00 $0.00 $0.00 05/05/2023
$0.00 $0.00 $3,449.00 05/03/2023
$0.00 $0.00 $364.00 05/02/2023
$0.00 $0.00 $0.00 04/28/2023
$0.00 $0.00 $0.00 05/03/2023

$0.00 $0.00 $642.00 05/10/2023

$49.42 $0.00 $3,718.76 04/28/2023
$0.00 $485.00 $0.00 04/28/2023
$26.64 $0.00 $325.00 04/28/2023
$0.00 -$65.20 $642.00 05/10/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 $660.00 $0.00 11/02/2022
$0.00 $0.00 $0.00 04/13/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 -$60.00 $642.00 04/28/2023
$0.00 $0.00 $375.00 05/10/2023
$0.00 $0.00 $375.00 04/27/2023
$0.00 $0.00 $375.00 04/27/2023
$0.00 $850.00 $0.00
$0.00 $0.00 $0.00 04/27/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 $0.00 $0.00 04/27/2023
 $0.00 $0.00 $1,363.00 04/28/2023
$0.00 -$50.00 $0.00 04/27/2023
$0.00 $112.35 $642.00 04/27/2023
$0.00 -$0.04 $0.00 04/27/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 -$36.00 $0.00 05/01/2023
$0.00 $2,029.29 $0.00 05/10/2023
$0.00 $348.14 $0.00 04/27/2023
$0.00 $0.00 $0.00 04/17/2023
$0.00 $210.90 $0.00 05/10/2023
$0.00 $0.00 $0.00 04/28/2023
$0.00 $0.00 $1,389.00 05/08/2023
$0.00 $0.00 $838.00 04/28/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 $15.00 $838.00 04/28/2023
$0.00 $0.00 $2,794.00 05/03/2023
$0.00 $0.00 $0.00 04/28/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 $110.14 $0.00 04/26/2023
$0.00 $0.00 $0.00 05/03/2023
$0.00 $0.00 $0.00 05/10/2023

$0.00 $5.00 $0.00 04/27/2023

$0.00 $344.96 $0.00 04/27/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 $25.00 $1,125.00 04/28/2023
$254.29 $0.00 $9,167.71 05/04/2023
$0.00 $0.00 $0.00 05/08/2023
$0.00 $640.00 $0.00 04/28/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 $60.00 $0.00 05/10/2023
$0.00 -$66.00 $0.00 04/27/2023
$0.00 -$40.00 $642.00 04/27/2023
$0.00 $12.42 $0.00 04/27/2023
$0.00 $0.00 $642.00 04/28/2023
$0.00 $15.00 $0.00 05/04/2023
$0.00 $0.00 $0.00 05/10/2023
$0.00 $0.00 $0.00 05/08/2023
$0.00 $0.00 $0.00 04/27/2023
$0.00 $0.00 $0.00 05/05/2023
$0.00 $40.00 $0.00 04/27/2023
$0.00 $483.00 $0.00 04/27/2023
$0.00 $486.76 $0.00 04/27/2023
$0.00 $0.00 $838.00 04/27/2023
$0.00 $0.00 $642.00 05/04/2023
$0.00 $50.00 $0.00 04/27/2023
$0.00 $183.81 $0.00 04/28/2023
$0.00 $40.00 $0.00 04/27/2023
$0.00 $0.00 $642.00 05/10/2023
$0.00 $0.00 $838.00 05/03/2023
$0.00 $0.00 $0.00 04/27/2023
Last Patient Payment Patient Last Payment Amount
04/28/2023 $12.45
$0.00
$0.00
09/01/2020 $25.00
04/28/2023 $30.00
04/28/2023 $56.00
$0.00
05/06/2022 $37.75
05/02/2023 $30.43
$0.00
$0.00
04/28/2023 $150.00
$0.00
04/29/2022 $40.00
$0.00
$0.00
$0.00
04/28/2023 $60.00
04/28/2023 $30.00
04/28/2023 $115.00
02/14/2023 $30.00
04/28/2023 $45.00
$0.00
03/10/2023 $17.31
03/31/2023 $100.00
04/18/2023 $20.00
03/31/2023 $120.00
05/05/2023 $20.00
04/25/2023 $50.00
$0.00

01/26/2023 $70.00

$0.00

04/28/2023 $30.00

04/28/2023 $30.00
04/21/2022 $35.00
$0.00
05/05/2023 $90.00
$0.00
$0.00
04/22/2023 $12.45
03/20/2023 $16.00
$0.00
$0.00
05/05/2023 $25.00
$0.00

07/20/2021 $10.00
$0.00
$0.00
03/28/2023 $50.00
04/28/2023 $50.00
03/02/2023 $147.14
02/22/2023 $54.00
$0.00
03/07/2023 $50.00
03/31/2023 $30.00
$0.00
$0.00
02/22/2023 $30.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

01/21/2022 $35.00
$0.00
03/03/2023 $30.00
$0.00
03/17/2023 $129.60
03/31/2023 $25.00
$0.00
04/14/2023 $15.00
03/29/2023 $25.00
04/28/2023 $40.00
$0.00
$0.00
$0.00
$0.00
04/27/2023 $45.00
$0.00
$0.00
 $0.00
05/02/2023 $50.00
04/27/2023 $100.00
04/25/2023 $23.00
05/03/2023 $10.00
04/28/2023 $30.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

01/23/2023 $30.00
04/11/2023 $115.00
02/15/2023 $318.43
$0.00
04/28/2023 $15.00
$0.00
02/10/2023 $50.00
04/28/2023 $92.86
04/05/2023 $60.00
02/08/2023 $36.00
04/27/2023 $20.00
02/16/2023 $30.00
$0.00
04/07/2023 $35.00
$0.00
$0.00
05/01/2023 $60.00
04/28/2023 $120.00
04/14/2023 $40.00
04/28/2023 $50.00
03/03/2023 $32.21
$0.00
$0.00
 $0.00
04/28/2023 $34.50
$0.00
$0.00
$0.00
$0.00
 Appointment Comment
Coins: $12.45
Balance:
Copay: $406.05
$0.00
balance: $0.00
Copay: $0.00
Balance: $116.54
Copay: 0.0
Balance: $0.00
Copay: $30.00
Balance: $30.00
Copay: $25.00
Balance: $54.59
Copay: $0.00
Balance: $30
Copay: $150.00
Balance:
Copay: $1140.00
$30.00
Balance: $60.43
Copay: $0.00
Balance: $0.00
Copay: $0.00
Balance: $0.00
Copay: $150.00
Balance:
Copay: $745.00
$0.00
Balance: $0.00
Copay: $0.00
Balance: Prepaid$80.00
Copay: $0.00
Balance: $0.00
Copay: $0.00
Balance: $360
Copay: $0.00
Balance:
Copay: $131.68 $0.00Deductible
Towards
Balance: $320.60
Copay: $30.00
Deductible:$30.00
Balance: $115.37
Balance: $329.17
Copay: $30.00
Balance: $90.00
Copay: $15.00
Balance: $45.00
Copay: $0.00
Deductible: $0.00
Balance: $118.37
Balance: $330.10
Copay: $50.00
Balance: $100.00
Copay: $11.26
Balance:
Copay:$11.26
$60
Balance: $120
Copay: $20.0
Balance: $40.00
Copay: $0.00
Balance: $0.00
Insurance Terminated

Copay: $0.00
Balance: Prepaid$70.00
Copay: $0.00
Balance: $0.00
Copay: $30.00
Balance: $55.00
Copay: $0.00
Balance: $0.00
Copay: $0.00
Balance: Prepaid
Copay: $10.00
$0.00
Balance: $0.00
Copay: $30.00
Balance:
Copay: $145.00
$0.00
Balance: $0.00
Copay: $0.00
Balance: $0.00
Co-ins: $12.45
Balance: $12.45
 Copay: $0.00
Balance:Auth Req $40.15
Prepaid
Copay: $0.00
Copay: $0.00
Balance: $0.00
Balance: $0.00
Copay: $25.00
Balance: $25.00
MENTEL HEALTH NOT COVERED.

Copay: $0.00
Balance: Prepaid
Copay: $0.00$10.00
Balance: $0.00
Copay: $0.00
Balance: $0.00
Copay: $50.00
Balance:
Copay:$60.00
$50
Balance: $50
Copay: $24.08
Balance: $72.24
Deductible: $114.99
Balance: $464.97
Deductible: 100.27
Balance: $126.28
Copay: $10.00
Balance: Prepaid$20.00
Copay: $30.00
Balance: $30.00
Copay: $0.00
Balance: $0.00
Copay: $0.00
Balance:
Copay: $.00
$70.00
Balance:
Copay: $250.00
$0.00
Balance:
Copay: $0.00
$30
Balance: $60
Copay: $0.00
Balance: $0.00
Copay: $30.00
Balance: $60.00
Copay: $0.00
Balance: $0.00
Copay: $0.00
Balance: $0.00
Copay: $0.00
Balance: $0.00
Financial info missing

Copay:$0.00
Balance:$0.00
Copay: $0.00
Balance: $0.00
Copay: $25.00
Balance:
Copay: $510.00
$0.00
Balance: $0.00
Patient is on Deductible
Balance: Prepaid
Copay: $25.00$65.20
Balance: $25.00
Copay: $150.00
Balance: $810.00
Copay: $15.00
Balance: $15.00
Copay: $25.00
Balance: $25.00
Copay: $20.00
Balance: $40.00
Copay: $0.00
Balance: $0.00
Copay: $0.00
Balance: $0.00
Copay: $0.00
Balance: $0.00
Copay: $150.00
Balance:
Copay:$1,000.00
$45.00
Balance: $90.00
Copay: $0.00
Balance: $0.00
Copay: $0.00
Balance: $0.00
 Copay: $0.00
Balance: $0.00
Copy: $50.00
Balance: $50.00
Copay: $0.00
Balance: $112.35
Co-ins: $22.99
Balance: $22.95
Copay: $10.00
Balance: $20.00
Copay: $30.0
Balance: $24.00
Co-ins: $24.08
Balance: $688.45
Inactive insurance
Balance:
AUTH $348.14
REQ Copay: $0.00
Balance: $0.00
Copay: $25.00
Balance:
Copay: $235.90
$0.00
Balance: $0.00
Copay: $35.00
Balance: $70.00
Auth req
Balance: $65.93
Auth Req
Copay: $15
Balance: $45
Copay: $0.00
Balance: $0.00
Copay: $0.00
Balance: $0.00
Copay: $0.0
Balance: $0.00
Copay: $0.0
Coinsurance:$0.00
Balance: $34.80
Balance: $34.80
Coinsurance: $34.50
Balance: $34.50
Copay: $30.00
Deductible:$35.00
Balance: $114.99
Balance:
Copay: $106.43 $344.96
Towards Deductible
Balance: $0.00
Copay: $0.00
Balance: $25.00
Copay: $15.00
Balance: $15.00
Copay: $0.00
Balance: $0.000
Inactive Insurance.
Deductible: $115.37
Balance: $92.86
Copay: $30.00
Balance: $90.00
Copay: $36.00
Balance: Prepaid
Copay: $20.0$30.00
Balance: Prepaid
Copay: $20.00
$0.00
Balance: $12.42
Copay: $0.00
Balance:
Copay: $0.00
$35
Balance: $35
Copay: $0.00
Balance: $0.00
Copay: $0.00
Balance: $0.00
Copay: $30.00
Balance: $90.00
Copay: $30.00
Balance: $150.00
Copay: $40
Balance: $80
Copay: $25.00
Balance: $558.00
Deductible: $114.99
Balance: $371.77
Copay: $0.00
Balance: $0.00
Copay: $0.00
Balance: $0.00
 Copay: $25.00
Coinsurance: $34.50
Balance: $75.00
Balance: $252.81
Copay: $40.0
Balance: $80.0
Copay: $0.00
Balance: $0.00
Copay: $0.00
Balance: $0.00
Coinsurance: $47.88
Balance: $47.88.