Page 13 - Cover letter and evaluation for Lee Palmiter
P. 13
Client Data Sheet
Client ID: 5620079520 Rx Password Date: November 28, 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: 05/13/52
Date that Medicare became or will become primary (when
client has both Part A & Part B): 01/01/19
Client's home zip code: 07006
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? NA
Client's Selection Criteria Does the Medicare
web site indicate
that this doctor
Continue to see following physicians:
accepts Medicare-
approved rates?
Dr. Seth Jawetz Cardiology NA*
Dr. Coronello Porras Pulmonary NA*
Dr. Brian Schactman Internal Medicine Yes
* It is not unusual for doctors who belong to large medical groups not to be individually listed in the
Medicare provider directory
Client would like to see comparisons of both types of coverage
Prescription Drugs
Refill schedule: Monthly and mail-order
Pharmacy: CVS
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