Page 13 - Cover Letter and Medicare Evaluation for Eric Hartman
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Client Data Sheet
Client ID: 19970x7 Rx Password Date: November 18, 2022
Client's DOB: 11/05/44
Date that Medicare became or will become primary (when client
has both Part A & Part B): Already in effect
Client's home zip code: 92649
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 this provider
accept Medicare-
Continue to see following physicians:
approved rates?
Dr. Terry Fan, primary care Yes
Prescription Drugs
Current Refill Schedule: Mail order
Pharmacy: CVS or Walgreens
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