Page 12 - Cover letter and evaluation for Peter Smith
P. 12
Client Data Sheet
Client ID: 2579428096 Rx Password Date: November 27, 2017
Please verify the accuracy of the information below and let us know if
To the Client:
changes need to be made.
Client's DOB: 02/04/50
Date that Medicare became or will become primary (when client
has both Part A & Part B): Already past
Client's home zip code: 89129
Has client started receiving Social Security or SSDI payments? Yes
After client retires, will he or she have access to health insurance
through a spouse's or ex-spouse's employer plan? No
Client's Selection Criteria
Does the Medicare
web site indicate that
Continue to see following physicians: this doctor accepts
assignment?
Client may change his primary care physician and so currently has no
physicians that he plans to continue seeing
Client has a Medigap policy and plans to switch to a Medicare Advantage plan
Prescription Drugs
Refill Schedule: Mail-order
Pharmacy: Walgreens
6
