Page 13 - Cover Letter and Evaluation for Diann Weade
P. 13
Client Data Sheet
Client ID: 9741914122 Rx Password Date: October 30, 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: 11/23/51
Date that Medicare became or will become primary (when
client has both Part A & Part B): 11/01/16
Client's home zip code: 46814
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
Continue to see following physicians: that this doctor
accepts assignment?
Dr. Daniel Gabrek Periodontics No
Dr. Carol Garrean Internal Medicine Yes
Dr. Christina Mummert Optometry Yes
Dr. Thomas Teel Dental No
Client would like to see comparisons of both types of coverage
Prescription Drugs
Refill schedule: Monthly
Pharmacy: CVS or Walgreens
5
