Page 15 - Cover Letter & Evaluation for Mr. Henry Stiepel
P. 15
Client Data Sheet
Client ID: 11419 December 14, 2020
Please verify the accuracy of the information below and let us know if changes need to
be made.
Client's DOB: 04/11/56
Date that Medicare became or will become primary (when
client has both Part A & Part B): 04/01/21
Client's home zip code: 92692
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 wants a Medigap policy + stand-alone drug plan
Prescription Drugs Client's pharmacy: Sav-On
Refill Schedule: Monthly
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