Page 11 - Cover letter and evaluation for Paulina Rosenstein
P. 11
Client Data Sheet
Client ID: 411788 Rx Password Date: January 16, 2018
Please verify the accuracy of the information below and let us know if
To the Client:
changes need to be made.
Client's DOB: 01/02/53
Date that Medicare became or will become primary (when client
has both Part A & Part B): 02/01/18
Client's home zip code: 10031
Has client started receiving Social Security or SSDI payments? No
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 is interested only in Medigap policies
Prescription Drugs
Client will have Rx drug coverage through her
currently working husband's employer plan
5
