Page 11 - Cover letter and evaluation for Jay Newman
P. 11
Client Data Sheet
Client ID: 6432801440 Rx Password Date: May 9, 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: 12/20/51
Date that Medicare became or will become primary (when client
has both Part A & Part B): 01/01/17
Client's home zip code: 12546
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. Alan Hauptman Internal medicine Yes
Dr. Steven Lamm Internal medicine Yes
Dr. John Provet Urology Yes
Dr. Michael Whitlow Dermatology Not specified
Client is interested only in Medigap policies and wants the best coverage
Prescription Drugs
Refill Schedule: Monthly
C. O Bigelow Pharmacy
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