Title Last Found Source Due Date
Hypertension
Patients that had a health care provider visit in the last 12 months 2/5/2019 System 04/05/2020
Obesity
Patients that had a health care provider visit in the last 12 months 10/5/2015 System 12/05/2016
Title
Hypertension

Patients that had a health care provider visit in the last 12 months

Last Found

2/5/2019

Source

System

Due Date

04/05/2020

Title
Obesity

Patients that had a health care provider visit in the last 12 months

Last Found

10/5/2015

Source

System

Due Date

12/05/2016

Title Last Found Source Due Date
Mammogram for breast cancer screening 6/01/2021 System 06/01/2023
Pap smear for cervical cancer screening 4/6/2019 System 06/06/2023
Colonoscopy for colorectal cancer screening 2/14/2015 System 02/14/2025
Title

Mammogram for breast cancer screening

Last Found

6/01/2021

Source

System

Due Date

06/01/2023

Title

Pap smear for cervical cancer screening

Last Found

4/6/2019

Source

System

Due Date

06/06/2023

Title

Colonoscopy for colorectal cancer screening

Last Found

2/14/2015

Source

System

Due Date

02/14/2025

Title Last Found Source Due Date
Hypertension
Patients that had a health care provider visit in the last 12 months 2/5/2019 System 04/05/2020
Patients that had aserum creatine test in the last 12 months 11/2/2024 System 01/02/2023

Hypertension

Title

Patients that had a health care provider visit in the last 12 months

Last Found

2/5/2019

Source

System

Due Date

04/05/2020

Title

Patients that had aserum creatine test in the last 12 months

Last Found

11/2/2024

Source

System

Due Date

01/02/2023

Title Results Last Occurrence
Height 5'5 05/29/2021
Weight 220 11/2/2024
Body Mass Index 36.61 05/29/2021
Body Fat 05/29/2021
Title

Height

Results

5'5

Last Occurrence

05/29/2021

Title

Weight

Results

220

Last Occurrence

11/2/2024

Title

Body Mass Index

Results

36.61

Last Occurrence

05/29/2021

Title

Body Fat

Results

Last Occurrence

05/29/2021

Total cost : $108.76
Title Fill Date Quantity Days Copay Cost Provider/Pharmacy Category
NALTREXONE 50 MG TABLET 11/30/2021 30 30 $10.76 $32.36 / Giant Pharmacy 0155 OPIATE ANTAGONISTS
VITAMIN D2 1.25MG(50,000 UNIT) 11/30/2021 28 28 $0.75 $2.26 / Giant Pharmacy 0155 VITAMIN D
VALSARTAN-HCTZ 320-25 MG 11/14/2021 30 30 $7.76 $23.28 / Giant Pharmacy 0155 ANGIOTENSIN II RECEPTOR ANTAGONISTS D
Title

NALTREXONE 50 MG TABLET

Fill Date

11/30/2021

Quantity

30

Days

30

Copay

$10.76

Cost

$32.36

Provider/Pharmacy

/ Giant Pharmacy 0155

Category

OPIATE ANTAGONISTS

Title

VITAMIN D2 1.25MG(50,000 UNIT)

Fill Date

11/30/2021

Quantity

28

Days

28

Copay

$0.75

Cost

$2.26

Provider/Pharmacy

/ Giant Pharmacy 0155

Category

VITAMIN D

Title

VALSARTAN-HCTZ 320-25 MG

Fill Date

11/14/2021

Quantity

30

Days

30

Copay

$7.76

Cost

$23.28

Provider/Pharmacy

/ Giant Pharmacy 0155

Category

ANGIOTENSIN II RECEPTOR ANTAGONISTS D

Total claims Paid : $108.76    Claims: 10
Title Total Cost Provider / Place of Service Diagnosis
199396 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidanceltisk factor reduction, interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years $114.76 HOWARD COUNTY GENERAL HOSPITAL, INC, 1 11 Office 0000 Encounter for general adult medical examination without abnormal findings
VITAMIN D2 1.25MG(50,000 UNIT) 11/30/2021 28 28
93000 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report 41/9/2021 $114.76 HOWARD COUNTY GENERAL HOSPITAL, INC, 1 11 Office 0000 Encounter for general adult medical examination without abnormal findings
Title

199396 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidanceltisk factor reduction, interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years

Total Cost

$114.76

Provider / Place of Service

HOWARD COUNTY GENERAL HOSPITAL, INC, 1 11 Office

Diagnosis

0000 Encounter for general adult medical examination without abnormal findings

Title

199396 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidanceltisk factor reduction, interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years

Total Cost

$114.76

Provider / Place of Service

HOWARD COUNTY GENERAL HOSPITAL, INC, 1 11 Office

Diagnosis

0000 Encounter for general adult medical examination without abnormal findings