Page 13 - Cover Letter and Medicare Evaluation for Donald Pender
P. 13
Client Data Sheet
Client ID: 638821 Rx Password Date: October 20, 2021
Please verify the accuracy of the information below and let us know if
To the Client:
changes need to be made.
Client's DOB: 11/27/55
Date that Medicare became or will become primary (when client
has both Part A & Part B): 01/01/22
Client's home zip code: 92603
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
Continue to see following physicians:
Dr. Timothy Chen Internist
Client would like to see comparisons of both types of coverage
Prescription Drugs
Current refill schedule: Mail Order
Local Pharmacy: Rite Aid
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