Page 15 - Cover letter and evaluation for Carol Smith
P. 15
Client Data Sheet
Client ID: 7877245 Rx Password Date: December 1, 2017
Please verify the accuracy of the information below and let us know if
To the Client:
changes need to be made.
NA = Not available
Client's DOB: NA
Date that Medicare became or will become primary (when client
has both Part A & Part B): 01/01/18
Client's home zip code: 89129
Has client started receiving Social Security or SSDI payments? NA
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
Continue to see following physicians: this doctor accepts
assignment?
Client does not currently have a primary care physician
Client wishes to compare Medicare Advantage plans
Prescription Drugs
Refill Schedule: NA
Pharmacy: Walgreens
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