Page 11 - Cover Letter and Evaluation for Mr. Michael Johnson
P. 11
Client Data Sheet
Client ID: 44919 November 6, 2019
Please verify the accuracy of the information below
Client's DOB: 06/26/54
Date that Medicare became or will become primary (when
client has both Part A & Part B): 06/01/19
Client's home zip code: 90005
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
this doctor accepts
Continue to see following physicians:
Medicare-approved
rates?
Dr. Matthew Bui urology Yes
Dr. Allen Lew cardiology Yes
Dr. Brian Perry orthopedic surgery Yes
Dr. Soroya Ross gastroenterology Yes
Client is interested only in Medigap policies
Prescription Drugs
Pharmacy Rite Aid
Refill schedule Monthly
5
