Page 15 - Cover Letter and Evaluation for Melanie
P. 15
Client Data Sheet
Client ID: 8186191616 Rx Password Date: May 1, 2018
Please verify the accuracy of the information below and let us know if
To the Client:
changes need to be made.
Client's DOB: 12/07/49
Date that Medicare became or will become primary (when client
has both Part A & Part B): 08/01/18
Client's home zip code: 75069
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
Continue to see following physicians: this doctor accepts
assignment?
Dr. Maisha Barnes Gastroenterology Yes
Dr. Michele Del Vicario Cardiovascular Yes
Dr. Akram Kahn Cardiovascular Yes
Dr. Janet Hyun Lee Family medicine Yes
Dr. John Regan Orthopedic Yes
Dr. Sandra Rogers Family medicine Not listed
Client is interested only in Medigap policies
Prescription Drugs
Refill Schedule: Both monthly and mail-order
Pharmacy: CVS
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