Clinic County Clinic Name Clinic Address Clinic City Clinic Participant .

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Clinic County Clinic NameClinic AddressClinic CityClinic ParticipantZipCountyParticipant EnrollmentGenderStatusFax ReceivedDateADAIRRASMUSSEN, CASSIE DR - IAM609 SE CKETT, JUSTIN - IAMPO BOX 295KIRKSVILLE63501APPANOOSEMaleAccepted FC4/15/2014ADAMSLENOX MEDICAL CLINICNODAWAY50857TAYLORMaleAccepted FC4/28/2014ALLAMAKEEEVERMAN, JESSICA - LLAMAKEEGUNDERSON HEALTH SYSTEM - WAUKONWAUKON52172ALLAMAKEEFemaleDeclined FC4/12/2014APPANOOSEBLACKLEDGE, PATRICIA - IAM1015 N 18TH STCENTERVILLE52544APPANOOSEFemaleAccepted FC4/28/2014APPANOOSEBLACKLEDGE, PATRICIA - IAM1015 N 18TH STCENTERVILLE52544MONROEFemaleAccepted FC4/17/2014APPANOOSEBLACKLEDGE, PATRICIA - IAM1015 N 18TH 14APPANOOSEBLACKLEDGE, PATTY - IAM1015 N 18TH ST STE CCENTERVILLE52544APPANOOSEMaleAccepted FC4/15/2014APPANOOSEBLACKLEDGE, PATTY - IAM1015 N 18TH ST STE PPANOOSEPARRISH, CASSIE ARNP - IAM19876 ST JOSEPH DRCENTERVILLE52544APPANOOSEFemaleAccepted FC4/24/2014APPANOOSEPARRISH, CASSIE ARNP - IAM19876 ST JOSEPH DRCENTERVILLE52544Not AskedUnreachable4/16/2014AudubonCHANCE, VIVIAN - IAM222 BROADWAY STAUDUBONFemaleAccepted FC4/28/2014BENTONATKINS FAMILY MEDICAL CLINICNot AskedDeclined FC4/4/2014BENTONHOLMES, KARL PAC - IAMBENTON120 2ND AVE SEAUDUBONATKINS522061010 8TH AVEBELLE PLAINE52208BENTONMaleAccepted FC4/8/2014HOFFMAN, JULIE ARNP - IAM400 CANTON ST # B NWSHELLSBURG52332BENTONMaleAccepted FC4/23/2014BENTONHOFFMAN, JULIE ARNP - IAM400 CANTON ST # B ENTONBURNS, MICHELLE - IAMURBANA52345LINNFemaleAccepted FC4/23/2014BentonMESCHER, DEB PAC - IAM1010 8TH AVEBELL PLAINEBENTONFemaleAccepted FC4/16/2014BentonMESCHER, DEB PAC - IAM1010 8TH AVEBELL PLAINEBENTONFemaleAccepted FC4/16/2014BLACK HAWKARROWHEAD MEDICAL CENTERCEDAR FALLS50613BLACK HAWKNot AskedActive4/29/2014BLACK HAWKCOVENANT CLINIC - CEDAR FALLSCEDAR FALLS50613BLACK HAWKNot AskedDeclined FC4/1/2014BLACK HAWKDODD, KHUSHMAN - IAMCEDAR FALLS50613BUTLERFemaleAccepted FC4/17/2014BLACK HAWKGLASCOCK, DAN MD - IAMCEDAR FALLS50613Not AskedUnreachable4/17/2014BLACK HAWKHILLMAN, MARCIA - IAM226 BLUEBELL DRCEDAR FALLS50613BLACK HAWKFemaleAccepted FC4/28/2014BLACK HAWKKAISER, TARA ARNP - IAM1824 W 8TH STCEDAR FALLS50613GRUNDYNot AskedUnreachable4/11/2014BLACK HAWKREINERTSON, RANDAL MD - IAM516 S DIVISION STCEDAR FALLS50613BLACK HAWKNot AskedActive4/30/2014BLACK HAWKSANDELL, JULIE - IAM226 BLUEBELL RDCEDAR FALLS50613BLACK HAWKFemaleAccepted FC4/23/2014BLACK HAWKSANDELL, JULIE - IAM226 BLUEBELL RDCEDAR FALLS50613BLACK HAWKNot AskedUnreachable4/24/2014BLACK HAWKSTANDING, LARRY226 BLUEBELL RDCEDAR FALLS50613BLACK HAWKNot AskedUnreachable4/22/2014BLACK HAWKJAOUDE, JEAN MD - IAM3701 LAFAYETTE RDEVANSDALE50707BLACK HAWKMaleAccepted FC4/16/2014BLACK HAWKKEENAN, MARY - IAM3701 LAFAYETTE RDEVANSDALE50707BLACK HAWKFemaleAccepted FC4/12/2014BLACK HAWKKEENAN, MARY - IAM3701 LAFAYETTE RDEVANSDALE50707BLACK HAWKFemaleAccepted FC4/15/2014BLACK HAWKLIES, MARILYN MD - IAMEVANSDALE50707BLACK HAWKFemaleAccepted FC4/24/2014BLACK HAWKLIES, MARILYN MD - IAMEVANSDALE50707BLACK HAWKNot AskedActive4/15/2014BLACK HAWKSTENGER, QUENTIN - IAM37010 LAFAYETTE RDEVANSDALE50707BLACK HAWKMaleAccepted FC4/28/2014BLACK HAWKCHRIST, MEREDITH - IAM1015 S HACKETT RDWATERLOOBLACK HAWKMaleAccepted FC4/17/2014BLACK HAWKALLEN OB/GYNNot AskedDeclined FC4/30/2014BLACK HAWKBALL, EMILY ARNP - IAMBLACK HAWK1824 W 8TH STWATERLOO507031015 S HACKETT STE100WATERLOO50701BLACK HAWKFemaleAccepted FC4/7/2014BALL, EMILY ARNP - IAM1015 S HACKETT STE100WATERLOO50701BLACK HAWKNot AskedUnreachable4/11/2014BLACK HAWKBERRY, CARRIE ARNP - IAM905 FRANKLIN STWATERLOO50703BLACK HAWKMaleAccepted FC4/4/2014BLACK HAWKBUHR, BRENT - IAM905 FRANKLIN STWATERLOO50703KOSSUTHNot AskedUnreachable4/23/2014BLACK HAWKBUHR, BRENT DR - IAM905 FRANKLIN STWATERLOO50703Not AskedActive4/29/2014BLACK HAWKCARE FOR YOURSELF PROGRAMWATERLOO50703BUCHANANFemaleAccepted FC4/2/2014BLACK HAWKCHRIST, MEREDITH - IAMWATERLOO50701BLACK HAWKFemaleActive4/30/20141015 S HACKETT RD

Clinic County Clinic NameClinic AddressClinic CityClinic ParticipantZipCountyParticipant EnrollmentGenderStatusFax ReceivedDateBLACK HAWKCHRIST, MEREDITH - IAM1015 S HACKETT RDWATERLOO50701BLACK HAWKFemaleUnreachable4/21/2014BLACK HAWKCRAIG, MICHELLE DR - IAMWATERLOO50702BLACK HAWKFemaleAccepted FC4/23/2014BLACK HAWKDIB, JOUD - IAM2710 ST FRANCIS DR STE210419 E DONALD STWATERLOO50703BLACK HAWKFemaleActive4/21/2014BLACK HAWKENGHOLM, ISSAC DR - IAM2055 KIMBALL AVE STE 101 WATERLOO50702BLACK HAWKMaleAccepted FC4/11/2014BLACK HAWKGOETSCH, NICHOLAS DO - IAMWATERLOO50701BLACK HAWKFemaleAccepted FC4/9/2014BLACK HAWKGRAFFT, CYD ARNP - IAM1731 W RIDGEWAY AVESTE 1003251 W 9TH STWATERLOO50702Not AskedActive4/30/2014BLACK HAWKHARTER, GREG MD - IAMWATERLOO50702BLACK HAWKFemaleAccepted FC4/10/2014BLACK HAWKHARTER, GREG MD - IAMWATERLOO50702BLACK HAWKFemaleAccepted FC4/7/2014BLACK HAWKHENDERSON, VICKI - IAM2710 ST FRANCIS DR STE2102710 ST FRANCIS DR STE210905 FRANKLIN STWATERLOO50703BLACK HAWKFemaleAccepted FC4/23/2014BLACK HAWKHENDERSON, VICKI - IAM905 FRANKLIN STWATERLOO50703BLACK HAWKFemaleUnreachable4/4/2014BLACK HAWKIJAZ, KIRAN - IAM905 FRANKLIN STWATERLOO50703BLACK HAWKFemaleAccepted FC4/17/2014BLACK HAWKIJAZ, KIRAN - IAM905 FRANKLIN STWATERLOO50703BLACK HAWKMaleAccepted FC4/2/2014BLACK HAWKIJAZ, KIRAN - IAM905 FRANKLIN STWATERLOO50703Not AskedDeclined FC4/17/2014BLACK HAWKIOWA SPINE & BRAIN INSTITUTEWATERLOO50702BLACK HAWKNot AskedDeclined FC4/15/2014BLACK HAWKIOWA SPINE & BRAIN INSTITUTEWATERLOO50702BLACK HAWKNot AskedUnreachable4/15/2014BLACK HAWKIOWA SPINE & BRAIN INSTITUTEWATERLOO50702BLACK HAWKNot AskedUnreachable4/8/2014BLACK HAWKIOWA SPINE & BRAIN INSTITUTEWATERLOO50702BLACK HAWKFemaleUnreachable4/8/2014BLACK HAWKIOWA SPINE AND BRAIN INSTITUTEWATERLOO50702BUTLERFemaleAccepted FC4/4/2014BLACK HAWKIOWA SPINE AND BRAIN INSTITUTEWATERLOO50702BLACK HAWKMaleAccepted FC4/4/2014BLACK HAWKIOWA SPINE AND BRAIN INSTITUTEWATERLOO50702Not AskedUnreachable4/2/2014BLACK HAWKIOWA SPINE AND BRAIN INSTITUTEWATERLOO50702Not AskedUnreachable4/2/2014BLACK HAWKLOUVIERE, HEIDI - IAM905 FRANKLIN STWATERLOO50702BLACK HAWKFemaleAccepted FC4/4/2014BLACK HAWKMASRI, MOHAMMED - IAM200 E K HAWKNGUYEN, MARIA MD2055 KIMBALL AVEWATERLOO50702Not AskedActive4/22/2014BLACK HAWKNOBLE, LANE - IAM2055 KIMBALL AVE STE 101 WATERLOO50702FemaleAccepted FC4/24/2014BLACK HAWKRIAD ZAKY, WAHID ALFONSE DR - IAM905 FRANKLIN STWATERLOO50703Not AskedActive4/29/2014BLACK HAWKSHREESHA, UDAYA DR - IAMWATERLOO50702Not CollectedAccepted FC4/29/2014BLACK HAWKSHREESHA, UDAYA DR - IAMWATERLOO50702BLACK HAWKMaleAccepted FC4/18/2014BLACK HAWKSMITH, MATTHEW MD - IAM2710 ST FRANCIS DR STE4022710 ST FRANCIS DR STE402212 W DALE STE 303WATERLOO50703BLACK HAWKFemaleAccepted FC4/18/2014BLACK HAWKYONNET, GAEL JEAN DR - IAM3421 W 9TH ST STE 100WATERLOO50702BUTLERMaleAccepted FC4/29/2014BLACK HAWKYONNET, GAEL JEAN DR - IAM3421 W 9TH ST STE 100WATERLOO50702BLACK HAWKFemaleAccepted FC4/10/2014BOONEMCINTIRE, TRACEY DRBOONE50036Not AskedUnreachable4/1/2014BOONEMEHLHAUS, BRIAN - IAM120 S STORY STBOONE50036BOONEMaleAccepted FC4/21/2014BOONEMEHLHAUS, BRIAN - IAM120 S STORY RMEIDE, JOEL DR - IAM120 S STORY STBOONE50036BOONEMaleAccepted FC4/2/2014BREMERRATHE, ANN MD312 9TH ST SWWAVERLYNot AskedUnreachable4/4/2014BREMERFAGRE, LEE - IAM21720TH ST NWWAVERLY50677BUTLERFemaleAccepted FC4/15/2014BREMERWAGNER, STACY - IAM312 9TH ST EPENDENCE50644BUCHANANNot AskedUnreachable4/8/2014BUCHANANDIAB - BUCHANAN CTY HC DIABETES SMED PRGRM - INDEPENDENCESMITH, ERICA - IAM1100 1ST ST EINDEPENDENCE50644BUCHANANFemaleAccepted FC4/16/2014BUCHANANSMITH, ERICA - IAM1100 1ST ST EINDEPENDENCE50644BUCHANANFemaleAccepted FC4/4/2014BLACK HAWK

Clinic County Clinic NameClinic AddressClinic CityClinic ParticipantZipCountyParticipant EnrollmentGenderStatusFax ReceivedDateBUCHANANSMITH, ERICA - IAM1100 1ST ST EINDEPENDENCE50644Buena VistaSCHALLER, NATALIE DO - IAM715 W MILWAUKEE AVESTORM LAKEBuena VistaGRANT, R ROY - IAM620 NORTHWESTERN DRBUTLERPROSE, HEIDI - IAM502 LOCUST STALLISONBUTLERCHAPIN, WENDY - IAM118 S MAIN STBUTLERCHAPIN, WENDY - IAMBUTLERNot AskedDeclined FC4/16/2014BUENA VISTAFemaleAccepted FC4/28/2014BUENA VISTAFemaleAccepted FC4/28/201450602BUTLERMaleAccepted FC4/1/2014CLARKSVILLE50619FLOYDFemaleAccepted FC4/7/2014118 S MAIN STCLARKSVILLE50619BUTLERFemaleAccepted FC4/21/2014CHAPIN, WENDY - IAM118 S MAIN STCLARKSVILLE50619BUTLERFemaleAccepted FC4/23/2014BUTLERCHAPIN, WENDY - IAM118 S MAIN STCLARKSVILLE50619BUTLERNot CollectedActive4/23/2014BUTLERDUCLOS, SHARON - IAM118 S MAINCLARKSVILLE50619BUTLERMaleAccepted FC4/28/2014BUTLERDUCLOS, SHARON - IAM118 S 4CALHOUNDUNCAN, DEREK - IAM1351 W MAIN STLAKE CITY51449CALHOUNFemaleAccepted FC4/1/2014CALHOUNLEPPERT, LISA ARNP - IAMMANSON50563CALHOUNFemaleAccepted FC4/9/2014CALHOUNLEPPERT, LISA ARNP - IAMMANSON50563Not AskedActive4/30/2014CARROLLCUMMINGS, NICOLE - IAMCARROLL51401Not AskedDeclined FC4/29/2014CARROLLMCFARLAND CLINICCARROLL51401CARROLLMaleAccepted FC4/8/2014CASSATLANTIC MEDICAL CENTERATLANTIC50022CASSMaleAccepted FC4/17/2014CASSBEAN, STACEY PAC1501 E 10THATLANTIC50022ADAIRMaleAccepted FC4/29/2014CASSBEAN, TODD - IAM1501 E 10THATLANTIC50022CASSMaleAccepted FC4/9/2014CASSFULLER, MARY - IAM1501 E 10THATLANTIC50022CASSFemaleAccepted FC4/2/2014CASSFULLER, MARY - IAM1501 E 10THATLANTIC50022AUDUBONFemaleAccepted FC4/29/2014CASSFULLER, MARY - IAM1501 E 10THATLANTIC50022CASSMaleAccepted FC4/22/2014CASSHIXSON, SCOTT PAC MPAS - IAM1501 E 10THATLANTIC50022CASSMaleAccepted FC4/22/2014CASSWILCOX, TRESSA - IAM1501 E 10TH STATLANTIC50022CASSFemaleAccepted FC4/23/2014CassFIEDLER, BRIAN - IAM1501 E 10TH STSHELBYFemaleAccepted FC4/3/2014CEDARPRUESS, ANNA ARNP - IAM411 1ST AVECLARENCE52216CEDARFemaleAccepted FC4/9/2014CEDARRAKE, NANCY - IAM305 MCKINLEY AVELOWDEN52255CLINTONFemaleAccepted FC4/7/2014CEDARJENNINGS, THERESA - IAM116 N 1ST STWEST BRANCH52358WASHINGTONNot AskedActive4/29/2014CERRO GORDOMIXDORF, TRACY - IAM1410 6TH AVE SCLEAR LAKE50428CERRO GORDOFemaleAccepted FC4/24/2014CERRO GORDOMASOOD, SHUMAILA - IAM621 S ILLINOIS AVE STE 100 MASON CITYCERRO GORDOMaleAccepted FC4/24/2014CERRO GORDOMASOOD, SHUMAILA - IAM621 S ILLINOIS AVE STE 100 MASON CITYCERRO GORDOMaleAccepted FC4/15/2014CERRO GORDOMASOOD, SHUMAILA - IAM621 S ILLINOIS AVE STE 100 MASON CITYCERRO GORDOMaleUnreachable4/1/2014CERRO GORDOMASOOD, SHUMAILA DR - IAM621 S ILLINOIS STE 100MASON CITYCERRO GORDOMaleAccepted FC4/17/2014CERRO GORDOCHOUDHRY, AISHA - IAM101 S TAYLOR AVEMASON CITY50401CERRO GORDOMaleAccepted FC4/7/2014CERRO GORDOCOOPER, RHONDA ARNP - IAM1010 4TH ST NW STE 240MASON CITY50401CERRO GORDOFemaleAccepted FC4/2/2014CERRO GORDOCOOPER, RHONDA ARNP - IAM1010 4TH ST NW STE 240MASON CITY50401CERRO GORDONot AskedActive4/29/2014CERRO GORDODEBRAH, JOANNE - IAM101 S TAYLOR AVEMASON CITY50401CERRO GORDOFemaleAccepted FC4/24/2014CERRO GORDODUNLAY, PATRICK - IAM1000 4TH ST SWMASON CITY50401CERRO GORDOMaleAccepted FC4/21/2014CERRO GORDOGARCIA, ANGEL DR - IAM621 S ILLINOIS AVEMASON CITY50401CERRO GORDOFemaleAccepted FC4/25/2014CERRO GORDOGARCIA, ANGEL DR - IAM621 S ILLINOIS AVEMASON CITY50401CERRO GORDOFemaleAccepted FC4/30/2014CERRO GORDOGARCIA, ANGEL DR - IAM621 S ILLINOIS AVEMASON CITY50401CERRO GORDOFemaleDeclined FC4/28/2014CERRO GORDOGRAY, TONYA DR - IAM1010 4TH STMASON CITY50401CERRO GORDOFemaleAccepted FC4/29/2014CERRO GORDOIQBAL, JAVERIA - IAM1000 4TH ST SWMASON CITY50401CERRO GORDOFemaleUnreachable4/7/2014CERRO GORDOMUKHERJI, GENEA - IAM101 S TAYLORMASON CITY50401Not AskedUnreachable4/7/2014CERRO GORDOQUINN, JONNA - IAM1010 4TH ST SWMASON CITY50401WORTHFemaleAccepted FC4/18/2014CERRO GORDOSINGH, PRANAV MD - IAM1000 4TH ST SWMASON CITY50401CERRO GORDOFemaleAccepted FC4/17/20141214 S GRANT RD

Clinic County Clinic NameClinic AddressClinic CityClinic ParticipantZipCountyParticipant EnrollmentGenderStatusFax ReceivedDateCERRO GORDOSINGH, PRANAV, MD1000 4TH ST SWMASON CITY50401CERRO GORDOFemaleAccepted FC4/18/2014CERRO GORDOSNYDER, STEVEN - IAM1000 4TH ST SWMASON CITY50401FRANKLINFemaleAccepted FC4/16/2014CERRO GORDOTIMPE, DONELL MD - IAM1010 4TH ST SWMASON CITY50428CERRO GORDOMaleAccepted FC4/21/2014CERRO GORDOTIMPE, DONELL MD - IAM1010 4TH ST SWMASON CITY50428CERRO GORDOFemaleAccepted FC4/25/2014CERRO GORDOSIEH, SUSAN - IAM1010 4TH ST SEMASONCERRO GORDOFemaleActive4/23/2014CHEROKEEHARRISON, PATRICIA - IAM300 SIOUX VALLEY DRCHEROKEE51012CHEROKEEFemaleAccepted FC4/4/2014CHEROKEEVANDELUNE, CHRIS DR - IAM300 SIOUX VALLEY DRCHEROKEE51012CHEROKEEFemaleAccepted FC4/1/2014CHEROKEEVEIT, STEPHEN - IAM212 E BOW DRCHEROKEE51012CHEROKEEMaleAccepted FC4/21/2014CLARKEHICKS, BEN - IAM827 S JACKSONOSCEOLACLARKEFemaleAccepted FC4/16/2014CLARKEHICKS, BEN - IAM827 S JACKSONOSCEOLACLARKEMaleAccepted FC4/21/2014CLARKECLARKE COUNTY HOSPITALCLARKEGILBERT, SUSAN ARNP - IAMCLARKEOSCEOLA50213ADAIRFemaleAccepted FC4/2/2014827 S JACKSONOSCEOLA50213CLARKEFemaleAccepted FC4/24/2014GILBERT, SUSAN ARNP - IAM827 S JACKSONOSCEOLA50213Not AskedUnreachable4/8/2014CLARKESTEWART, BROOKE - IAM827 S JACKSONOSCEOLACLARKEFemaleAccepted FC4/1/2014CLAYAVERA MEDICAL GROUP - SPENCERSPENCER51301CLAYMaleAccepted FC4/2/2014CLAYAVERA MEDICAL GROUP - SPENCERSPENCER51301CLAYNot AskedDeclined FC4/11/2014CLAYKEITH, DAVID - IAM116 E 11TH YROBISON, DAVID MD - IAM116 E 11TH STSPENCER51301CLAYFemaleActive4/30/2014CLAYSATHER, SONIA DR - IAM116 E 11TH STSPENCER51301Not AskedUnreachable4/3/2014CLAYWITT, TRAVIS - IAM116 E 11TH ST STE 101SPENCER51301CLAYMaleAccepted FC4/16/2014CLAYWITT, TRAVIS - IAM116 E 11TH ST STE 101SPENCER51301CLAYNot AskedUnreachable4/21/2014CLAYTONDANNER, KRISTINE DR - IAMWOODBURYMaleAccepted FC4/7/2014CLAYTONDANNER, KRISTINE DR - IAMPLYMOUTHFemaleAccepted FC4/4/2014CLAYTONBERNS, BARB ARNP - IAM345 W STEAMBOAT DR STE DAKOTA DUNES300345 W STEAMBOAT DR STE DAKOTA DUNES300911 CARTER ST NWELKADER52043CLAYTONFemaleAccepted FC4/23/2014CLINTONANSARI, ANIS DR - IAM915 13TH AVE NCLINTON52732CLINTONMaleAccepted FC4/9/2014CLINTONBREAUX, STEVEN MD - IAM240 N BLUFF BLVDCLINTON52732Not AskedActive4/29/2014CLINTONCARE FOR YOURSELF PROGRAM (CFY)CLINTON52732Not AskedUnreachable4/12/2014CLINTONFLORY, DONALD MD - IAM915 13TH AVE ARIOUS, MICHAEL - IAM638 S BLUFF BLVDCLINTON52732CLINTONMaleAccepted FC4/28/2014CLINTONMARILIM, MEL - IAM915 13TH AVE NCLINTON52732Not AskedUnreachable4/23/2014CLINTONO'SHEA, JOHN - IAM915 13TH AVE NCLINTON52732CLINTONFemaleAccepted FC4/28/2014CLINTONPLA, RAMON - IAM915 13TH PLA, RAMON - IAM915 13TH AVECLINTON52732CLINTONNot AskedActive4/23/2014CLINTONPLA, RAMON - IAM915 13TH AVECLINTON52732Not AskedDeclined FC4/29/2014CLINTONPLA, RAMON - IAM915 13TH AVECLINTON52732CLINTONNot AskedUnreachable4/2/2014CLINTONROBINSON, RANDY - IAM2027 S 21ST STCLINTON52732CLINTONMaleAccepted FC4/18/2014CLINTONSCHULTZ, KELLI ARNP - IAM240 N BLUFF BLVD STE 200 CLINTON52732Not AskedUnreachable4/17/2014CLINTONSCHULTZ, KELLI ARNP - IAM240 N BLUFF BLVD STE 200 CLINTON52732Not AskedUnreachable4/9/2014CLINTONSMITH, DENICE DR - IAM507 S 4TH STCLINTON52732Not AskedActive4/28/2014CLINTONBELL, JENNIFER - IAM1008 11TH STDE WITT52742Not AskedActive4/30/2014CLINTONWARHANK, ROSE MD - IAM1008 11TH STDE WITT52742Not AskedActive4/28/2014CrawfordMASON, RM - IAM1820 HWY 30EDENISONNot AskedUnreachable4/23/2014DALLASBOSHART, MACE PAC - IAM1120 GREENE STADEL50003DALLASFemaleAccepted FC4/11/2014DALLASDONAHUE, SUSAN - IAM1120 GREENE STADEL50003DALLASMaleAccepted FC4/4/2014CLINTON

Clinic County Clinic NameClinic AddressClinic CityClinic ParticipantZipCountyParticipant EnrollmentGenderStatusFax ReceivedDateDALLASHUANTE, DAVID - IAMPERRY50220DALLASMaleAccepted FC4/15/2014DALLASHUANTE, DAVID - IAMPERRY50220DALLASFemaleAccepted FC4/23/2014DALLASSARCONE, JULIE - IAM25 W HICKMAN RDWAUKEE50263POLKFemaleAccepted FC4/23/2014DallasMEDICI-FEICK, DEBORAH - IAM616 10TH STPERRYDALLASMaleAccepted FC4/1/2014DallasMEDICI-FEICK, DEBORAH - IAM616 10TH STPERRYNot AskedActive4/24/2014DAVISOLIVER, BEVERLY - IAM509 N MADISONBLOOMFIELD52537DAVISFemaleAccepted FC4/24/2014DAVISOLIVER, BEVERLY - IAM509 N MADISONBLOOMFIELD52537DAVISMaleAccepted FC4/24/2014DECATURLAMONI50140Not AskedDeclined FC4/23/2014DecaturCOMMUNITY HEALTH CENTERS OFSOUTHERN IALANE, HEIDI ARNP - IAM302 NE 14TH STLEONDECATURFemaleAccepted FC4/17/2014DecaturLANE, HEIDI ARNP - IAM302 NE 14TH STLEONMONROEFemaleAccepted FC4/9/2014DECATURNUNN-RYAN, REBECCA - IAM302 NE 14TH STLEON50144DECATURFemaleAccepted FC4/2/2014DECATURRICHARD, LARRY MD - IAM302 NE 14TH STLEON50144DECATURMaleAccepted FC4/1/2014DECATURRICHARD, LARRY MD - IAM302 NE 14TH STLEON50144DECATURFemaleAccepted FC4/16/2014DELAWAREBUDZINE, JANICE - IAM709 W MAIN STMANCHESTER52057BUCHANANFemaleAccepted FC4/28/2014DELAWAREBUSCHMAN, JILL - IAM709 W MAINMANCHESTER52057DELAWAREFemaleAccepted FC4/4/2014DELAWAREMEYER, DANIEL PAC - IAM709 W MAIN STMANCHESTER52057Not AskedUnreachable4/23/2014DES MOINESLAUER, GEORGIA PAC - IAM1706 W AGENCYBURLINGTON52601LEEFemaleAccepted FC4/1/2014DES MOINESLAUER, GEORGIA PAC - IAM1706 W AGENCYBURLINGTON52601DES MOINESFemaleAccepted FC4/4/2014DES MOINESLAUER, GEORGIA PAC - IAM1706 W AGENCYBURLINGTON52601DES MOINESFemaleAccepted FC4/28/2014DES MOINESCURRAN, PAULA - IAM1706 W AGENCY RD52655DES MOINESFemaleAccepted FC4/25/2014DES MOINESCURRAN, PAULA - IAM1706 W AGENCY RDWESTBURLINGTONWEST52655DES MOINESFemaleAccepted FC4/30/2014DES MOINESCURRAN, PAULA - IAM1706 W AGENCY RD52655DES MOINESFemaleAccepted FC4/3/2014DES MOINESVELHO-DENZ, VALERIE - IAM1225 S GEAR AVE STE 254BURLINGTONWESTBURLINGTONWEST52655DES MOINESFemaleAccepted FC4/30/2014BURLINGTONWESTBURLINGTONWEST52655DES MOINESMaleAccepted FC4/11/2014LEEFemaleAccepted FC4/16/2014LOUISANot CollectedAccepted FC4/16/2014DES MOINESVELHO-DENZ, VALERIE - IAM1225 S GEAR AVE STE 254DES MOINESREGALA, MITZI - IAM1706 W AGENCY RDDES MOINESREGALA, MITZI - IAM1706 W AGENCY RDDICKINSONFORD, BRIAN ROBERT - IAMDICKINSONKELLEY, JESSICA ARNP - IAMDICKINSONWARNER DIALYSIS CENTERDOUGLASAKKAD, HAYSAM - IAM4239 FARNAM #100DOUGLASBEER, ROBERT - IAM68130DUBUQUEKELCHEN, SHERRY - IAM17030 LAKESIDE HILLS PLZ OMAHA#130805 JOHNSON STCASCADEDUBUQUEBADGER, CHESTER - IAM1789 ELM ST STE ADUBUQUEDUBUQUEBADGER, CHESTER - IAM1789 ELM ST STE ADUBUQUEBADGER, CHESTER - IAMDUBUQUE2700 23RD STBURLINGTONWESTBURLINGTONSPIRIT LAKE51360DICKINSONFemaleAccepted FC4/23/20142700 23RD STSPIRIT LAKE51360DICKINSONMaleUnreachable4/28/2014SPIRIT LAKE51360Not AskedUnreachable4/24/2014OMAHA68131Not AskedUnreachable4/16/2014HARRISONFemaleAccepted FC4/24/201452033DUBUQUEFemaleAccepted FC4/30/201452001DUBUQUEMaleAccepted FC4/29/2014DUBUQUE52001DUBUQUEMaleAccepted FC4/21/20141789 ELM ST STE ADUBUQUE52001DUBUQUEMaleAccepted FC4/4/2014BADGER, CHESTER - IAM1789 ELM ST STE ADUBUQUE52001JACKSONFemaleAccepted FC4/8/2014DUBUQUEBADGER, CHESTER - IAM1789 ELM ST STE ADUBUQUE52001Not AskedActive4/18/2014DUBUQUEBADGER, CHESTER - IAM1789 ELM ST STE ADUBUQUE52001MaleDeclined FC4/8/2014DUBUQUEBADGER, CHESTER - IAM1789 ELM ST STE ADUBUQUE52001Not AskedUnreachable4/2/2014DUBUQUEBADGER, CHESTER - IAM1789 ELM ST STE ADUBUQUE52001Not AskedUnreachable4/21/2014DUBUQUEBADGER, CHESTER - IAM1789 ELM ST STE ADUBUQUE52001DUBUQUENot AskedUnreachable4/22/2014DUBUQUEBRIMEYER, BETTY - IAM1789 ELM STDUBUQUE52001DUBUQUEFemaleAccepted FC4/7/2014DUBUQUECAO, ZHENGJIN MD - IAM1515 DELHI ST STE 100DUBUQUE52001DUBUQUEFemaleAccepted FC4/17/2014DUBUQUEDUBUQUE INTERNAL MEDICINEDUBUQUE52001DUBUQUEFemaleAccepted FC4/11/2014DUBUQUE

Clinic County Clinic NameClinic AddressClinic CityClinic ParticipantZipCountyParticipant EnrollmentGenderStatusFax ReceivedDateDUBUQUEHANSON, KATIE - IAM200 MERCY DRDUBUQUE52001MaleAccepted FC4/18/2014DUBUQUEKHAN, TAUSEEF - IAMDUBUQUE52001Not AskedUnreachable4/16/2014DUBUQUEMCMAHON, KELLY - IAM350 N GRANDVIEW AVESTE 21454170 PENNSYLVANIA AVEDUBUQUE52002Not AskedActive4/30/2014DUBUQUEMOHR, JENNIFER DR - BUQUEMOHR, JENNIFER DR - BUQUEMOHR, JENNIFER DR - UQUEPOWERS, JILL DO - IAM1515 DELHI STDUBUQUE52001DUBUQUEMaleAccepted FC4/2/2014DUBUQUEREISEN, AMY ARNP - IAM1500 ASSOCIATES DRDUBUQUE52002DUBUQUEFemaleAccepted FC4/4/2014DUBUQUESALAS, HILARD MD - IAM1515 DELHI STREETDUBUQUE52001DUBUQUEFemaleAccepted FC4/4/2014DUBUQUESTILLE, RYAN - IAM1000 LANGWORTHYDUBUQUE52001DUBUQUEMaleAccepted FC4/18/2014DUBUQUETOBIN, JEAN PAC - IAM200 MERCY DR STE 200DUBUQUE52001DUBUQUEMaleAccepted FC4/24/2014DUBUQUETOBIN, JEAN PAC - IAM200 MERCY DR STE 200DUBUQUE52001Not AskedActive4/23/2014DubuqueSCHOPE, RONALD DR - IAM1515 DELHI STE 100DUBUQUEMaleUnreachable4/22/2014DubuqueSTILLE, CHRIS DR - IAM1000 LANGWORTHYDUBUQUEMaleAccepted FC4/28/2014FAYETTEATHERLEY, MICHAEL PAC129 8TH AVE SEOELWEIN50662BUCHANANFemaleAccepted FC4/18/2014FAYETTEATHERLEY, MICHAEL PAC - IAM129 8TH AVE SEOELWEIN50662BUCHANANFemaleAccepted FC4/30/2014FAYETTEATHERLEY, MICHAEL PAC - IAM129 8TH AVE ERNS, SARA PAC - IAM124 1ST AVE SEOELWEIN50662FAYETTEMaleAccepted FC4/2/2014FAYETTEUNITY POINT HEALTHOELWEIN50662FAYETTEMaleAccepted FC4/1/2014FAYETTECONNELLY, DARCY PAC - IAM110 JEFFERSON STWEST UNION52175CLAYTONFemaleAccepted FC4/4/2014FAYETTECONNELLY, DARCY PAC - IAM110 JEFFERSON STWEST UNION52175CLAYTONMaleAccepted FC4/4/2014FAYETTEMAKER, KATY - IAM110 JEFFERSON STWEST UNION52175FAYETTEFemaleAccepted FC4/17/2014FAYETTENOVAK, VICKI PAC - IAM110 JEFFERSON STWEST UNION52175FAYETTEMaleAccepted FC4/3/2014FLOYDSCHRODT, DAVID - IAM1501 S MAIN STE 1CHARLES CITY50616FLOYDFemaleAccepted FC4/10/2014FLOYDSCHRODT, DAVID - IAM1501 S MAIN STE 1CHARLES CITY50616CHICKASAWFemaleAccepted FC4/22/2014FLOYDSTARR, JOANNE ARNP - IAM1501 S MAIN ST STE 6CHARLES CITY50616FLOYDMaleAccepted FC4/9/2014FLOYDSTARR, JOANNE ARNP - IAM1501 S MAIN ST STE 6CHARLES CITY50616Not AskedActive4/22/2014FLOYDSTARR, JOANNE ARNP - IAM1501 S MAIN ST STE 6CHARLES CITY50616Not AskedUnreachable4/8/2014FRANKLINDENNIS, DAVID DO - IAM1720 CENTRAL AVE EHAMPTON50441CERRO GORDOFemaleAccepted FC4/16/2014FRANKLINDENNIS, DAVID DO - IAM1720 CENTRAL AVE EHAMPTON50441FRANKLINFemaleAccepted FC4/16/2014FRANKLINFRANKLIN MEDICAL CENTERHAMPTON50441BUTLERMaleAccepted FC4/11/2014FREMONTOURADA, MICHAEL MD - IAM1219 MAIN STHAMBURG51640FREMONTFemaleAccepted FC4/2/2014GREENECLEMONS, ROBERT DR - IAM1002 W LINCOLN WAYJEFFERSON50129GREENEMaleAccepted FC4/2/2014GREENECLEMONS, ROBERT DR - IAM1002 W LINCOLN WAYJEFFERSON50129GREENEMaleAccepted FC4/21/2014GREENECLEMONS, ROBERT DR - IAM1002 W LINCOLN WAYJEFFERSON50129Not AskedUnreachable4/8/2014GREENEPANAKOS, CONSTANTINE DO - IAM1002 W LINCOLN WAYJEFFERSON50129MaleAccepted FC4/22/2014GRUNDYKNUTSEN, MICHAEL101 EAST J AVEGRUNDY CENTER50638Not AskedDeclined FC4/29/2014GRUNDYWAGER, ALICIA ARNP - IAM501 MAIN STREINBECK50669GRUNDYFemaleAccepted FC4/23/2014HamiltonLATELLA, JOSEPH DR - IAM914 WILLSON AVEHAMILTONFemaleAccepted FC4/10/2014HamiltonLATELLA, JOSEPH DR - IAM914 WILLSON AVENot AskedActive4/28/2014HANCOCKLARSON, JULIE ARNP - IAM532 1ST ST NWBRITT50423HANCOCKNot AskedActive4/30/2014HANCOCKROSENMEYER, JENNIFER - IAM532 1ST ST NWBRITT50423HANCOCKFemaleAccepted FC4/1/2014HANCOCKROSENMEYER, JENNIFER - IAM532 1ST ST NWBRITT50423HANCOCKFemaleAccepted FC4/3/2014HANCOCKBOEDEKER, JOHN DR - IAM1010 4TH ST SW STE 120GARNER50438Not AskedUnreachable4/1/2014DUBUQUEGREENE

Clinic County Clinic NameClinic AddressClinic CityClinic ParticipantZipCountyParticipant EnrollmentGenderStatusFax ReceivedDateHANCOCKKANAWHA MEDICAL CLINICKANAWHA50447HANCOCKMaleAccepted FC4/24/2014HARDINOGAARD, GREG DR - IAM520 TALBOTT ST STE 1IOWA FALLS50126HARDINFemaleAccepted FC4/3/2014HARDINOGAARD, GREG DR - IAM520 TALBOTT ST STE 1IOWA FALLS50126Not AskedUnreachable4/1/2014HardinHAVERKAMP, KATIE - IAM520 TALBOTT STIOWA FALLSFRANKLINMaleAccepted FC4/4/2014HardinHAVERKAMP, KATIE - IAM520 TALBOTT STIOWA FALLSFRANKLINFemaleAccepted FC4/4/2014HARRISONGRADY, CARRIE MD - IAM128 W 8TH STLOGAN51546HARRISONFemaleAccepted FC4/9/2014HARRISONLOB, MARY MD - IAM122 W 8TH STLOGAN51546HARRISONNot AskedActive4/22/2014HARRISONCUNARD, ROBERT D - IAM809 E ELM STMISSOURI VALLEY51555HARRISONNot AskedUnreachable4/10/2014HARRISONCUNARD, ROBERT D - IAM809 E ELM STMISSOURI SONPESCHEL, SUSAN ARNP - IAM809 E ELM STMISSOURI VALLEY51555Not AskedActive4/28/2014HARRISONRICHTER, DANIEL DR - IAM809 E ELM STMISSOURI VALLEY51555HARRISONFemaleAccepted FC4/10/2014HENRYWAGNER, JULIE DO - IAM501 S WHITE STE 1MOUNT PLEASANT 52641HENRYFemaleAccepted FC4/24/2014HENRYWAGNER, JULIE DO - IAM501 S WHITE STE 1MOUNT PLEASANT 52641HENRYNot AskedActive4/15/2014HENRYMILLER, LINWOOD - IAM501 S WHITE STE 1MT PLEASANTHENRYNot AskedActive4/29/2014HENRYMILLER, LINWOOD - IAM501 S WHITE STE 1MT PLEASANTHENRYNot AskedUnreachable4/7/2014HENRYHENRY COUNTY HEALTH CENTERHENRYFemaleDeclined FC4/12/2014HENRYHENRY COUNTY HEALTH CENTERHENRYNot AskedUnreachable4/12/2014HOWARDJENSEN, PAUL - IAM321 8TH AVE WCRESCO52136HOWARDFemaleAccepted FC4/22/2014HOWARDKAMMERER, JON DR - IAM321 8TH AVE WCRESCO52136Not AskedUnreachable4/8/2014HOWARDMAHER, J DAVID - IAM321 8TH AVE WCRESCO52136Not AskedUnreachable4/16/2014HOWARDMAHER, J DAVID - IAM321 8TH AVE WCRESCO52136Not AskedUnreachable4/1/2014HOWARDVRECKE, TANYA - IAM321 8TH AVE RAK, LAINE MD - IAM1010 15TH ST NHUMBOLDT50548HUMBOLDTFemaleAccepted FC4/24/2014IDALUFT, MICHAEL - IAM101 2ND STIDA GROVE51445Not AskedAccepted FC4/10/2014IDALUFT, MICHAEL - IAM101 2ND STIDA GROVE51445IDAMaleUnreachable4/10/2014IDAVELTRI, ALBERT - IAM700 E 2ND STIDA GROVE51445IDAMaleAccepted FC4/1/2014IOWAMOHR, JOY PAC255 W LUCAS STMARENGO52301IOWANot AskedDeclined FC4/18/2014JACKSONPETERSEN, ERIC - IAM918 W PLATT ST #1MAQUOKETA52060JACKSONFemaleAccepted FC4/23/2014JACKSONTHOMPSON, KIMBERLY - IAM918 W PLATT #1MAQUOKETA52060JACKSONMaleAccepted FC4/21/2014JACKSONTHOMPSON, KIMBERLY - IAM918 W PLATT #1MAQUOKETA52060Not AskedActive4/23/2014JASPERDEJONG, DIANE PAC - IAM100 E SHERMANMONROE50170JASPERFemaleAccepted FC4/17/2014JASPERBANTELL, STEPHANIE - IAM300 N 4TH AVE E#200NEWTON50208JASPERFemaleAccepted FC4/23/2014JASPERBANTELL, STEPHANIE - IAM300 N 4TH AVE E#200NEWTON50208JASPERNot AskedUnreachable4/10/2014JASPERCHAN, TY - IAM300 N 4TH AVENEWTON50208JASPERFemaleAccepted FC4/28/2014JASPEREDWARDS, PATRICK - IAM300 N 4TH AVE ENEWTON50208JASPERMaleAccepted FC4/9/2014JASPERHAMID, SHOWKAT - IAM315 W 3RD ST NNEWTON50208JASPERMaleAccepted FC4/3/2014JASPERHILL, STEVEN - IAM300 N 4TH AVE STE 200NEWTON50208JASPERNot AskedActive4/15/2014JASPERHOLLOWAY, JODI ARNP - IAM315 W 3RD ST NNEWTON50208JASPERFemaleAccepted FC4/24/2014JASPERSIDDALL, LAURIE - IAM300 N 4TH AVE E STE 200NEWTON50208JASPERFemaleAccepted FC4/2/2014JEFFERSONANDERSON, DEREK DR - IAM2000 B SOUTH FFERSONCOCHRAN, TERRY MD - IAM2000 B S MAINFAIRFIELD52556WAPELLOMaleAccepted FC4/18/2014JEFFERSONROBISON, REGINA - IAM301 W BURLINGTON AVEFAIRFIELD52556DES MOINESFemaleAccepted FC4/25/2014JEFFERSONROBISON, REGINA - IAM301 W BURLINGTON AVEFAIRFIELD52556JEFFERSONMaleAccepted FC4/24/2014JEFFERSONROBISON, REGINA - IAM301 W BURLINGTON AVEFAIRFIELD52556DES MOINESMaleAccepted FC4/8/2014JEFFERSONROBISON, REGINA - IAM301 W BURLINGTON AVEFAIRFIELD52556JEFFERSONFemaleAccepted FC4/16/2014

Clinic County Clinic NameClinic AddressClinic CityClinic ParticipantZipCountyParticipant EnrollmentGenderStatusFax ReceivedDateJEFFERSONROBISON, REGINA - IAM301 W BURLINGTON AVEFAIRFIELD52556MaleAccepted FC4/11/2014JEFFERSONROBISON, REGINA - IAM301 W BURLINGTON AVEFAIRFIELD52556Not AskedActive4/23/2014JEFFERSONROBISON, REGINA - IAM301 W BURLINGTON 14JEFFERSONROBISON, REGINA - IAM301 W BURLINGTON AVEFAIRFIELD52556LEENot AskedUnreachable4/16/2014JEFFERSONROBISON, REGINA - IAM301 W BURLINGTON AVEFAIRFIELD52556LEENot AskedUnreachable4/2/2014JEFFERSONSCHLEICHER, MICHAEL - IAM2000 B S MAINFAIRFIELD52556JEFFERSONFemaleAccepted FC4/16/2014JEFFERSONSCHLEICHER, MICHAEL - IAM2000 B S MAINFAIRFIELD52556JEFFERSONMaleAccepted FC4/21/2014JEFFERSONZIELINKSI, BETH - IAM2000 S MAIN STFAIRFIELD52556HENRYFemaleAccepted FC4/24/2014JohnMILLER, DELWYN - IAM200 HAWKINS DRIOWA CITYJOHNSONMaleAccepted FC4/21/2014JohnsonTAN, CAROL - IAMCORALVILLEJOHNSONMaleAccepted FC4/16/2014JOHNSONBECK, GWEN - IAM2769 HEARTLAND DR STE205105 E 9TH STCORALVILLE52241LEEFemaleAccepted FC4/21/2014JOHNSONBIEBER, DALE MD - IAM105 E 9TH STCORALVILLE52241JOHNSONFemaleAccepted FC4/16/2014JOHNSONBIEBER, DALE MD - IAM105 E 9TH ONBURSTAIN, TODD - IAM105 E 9TH STCORALVILLE52241JOHNSONFemaleAccepted FC4/17/2014JOHNSONBURSTAIN, TODD - IAM105 E 9TH STCORALVILLE52241Not AskedActive4/29/2014JOHNSONDIRKSEN, RACHAEL - IAM105 E 9TH STCORALVILLE52241JOHNSONFemaleAccepted FC4/4/2014JOHNSONHEGEMAN, ROBERT - IAM105 E 9TH STCORALVILLE52241JOHNSONFemaleAccepted FC4/25/2014JOHNSONHEGEMAN, ROBERT - IAM105 E 9TH STCORALVILLE52241JOHNSONFemaleAccepted FC4/3/2014JOHNSONKIENZLE, MICHAEL DR - IAM105 E 9TH STCORALVILLE52241JOHNSONFemaleAccepted ed FC4/29/2014JOHNSONUIHC DERMATOLOGYU AT IOWA RIVERLANDINGWIBLIN, RAYMOND TODD MD - IAM105 9TH STCORALVILLE52241DES MOINESMaleAccepted FC4/16/2014JOHNSONWIBLIN, RAYMOND TODD MD - IAM105 9TH NSONABERNAT

Clinic County Clinic Name Clinic Address Clinic City Clinic Zip Participant County Participant Gender Enrollment Status Fax Received Date BLACK HAWK CHRIST, MEREDITH - IAM 1015 S HACKETT RD WATERLOO 50701 BLACK HAWK Female Unreachable 4/21/2014

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