Page 13 - Cover Letter and Evaluation for Marilyn Shelton
P. 13
Client Data Sheet
Date of Evaluation: October 31, 2019
Please verify the accuracy of the information below
Client's DOB: 6/25//1949
Date that Medicare became or will become primary (when
client has both Part A & Part B): 01/01/20
Client's home zip code: 92011
Has client started receiving Social Security or SSDI payments? Yes
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. David Ko Internist Yes
Dr. Gay Walker Internist Yes
Dr. Martin CharlAt Cardiologist Yes
Dr. Nicole Fram Ophthalmologist Yes
Dr. Matthew Kirk Ophthalmologist Yes
Dr. Andrew Hsing Pulmonologist Yes
Dr. Steven DiLauro Gastroenterologist Yes
Comprehensive Dermatologists Yes
Dermatology Group
Client wishes to acquire a Medigap policy
Prescription Drugs
Pharmacy Rite Aid, CVS, or Pharmica
Refill schedule Mail order
5
