Page 15 - Cover Letter and Evaluation for Dr. Jim Fisgus
P. 15
Client Data Sheet
Client ID: 9393356832 February 25, 2019
Please verify the accuracy of the information below and let us know if changes need to
be made.
Client's DOB: 01/08/50
Date that Medicare became or will become primary (when
client has both Part A & Part B): NA
Client's home zip code: 91737
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
this doctor accepts
Continue to see following physicians:
Medicare-approved
rates?
Dr. Jeffrey Canceko Internal medicine Yes
Dr. Steven DeMeester Cardiothoracic surgery Yes
Dr. Mihir Desai Urology Yes
Dr. Wilke Liem Dermatology Yes
Client wishes to compare both types of supplemental coverage
Prescription Drugs
Pharmacy CVS
Refill schedule Mail-Order
5
