Page 19 - Cover letter and evaluation for Thomas Barr
P. 19
Client Data Sheet
Client ID: 0585196480 Rx Password Date: October 14, 2017
Please verify the accuracy of the information below and let us know if
To the Client:
changes need to be made.
Client's DOB: 10/04/45
Date that Medicare became or will become primary (when client
has both Part A & Part B): 01/01/18
Client's home zip code: 21012
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
Continue to see following physicians: this doctor accepts
assignment?
Dr. William Dabbs General practice Yes
Dr. John Kennedy Cardiology Yes
Dr. Anthony Calabrese Gastroenterology Yes
Dr. Adrienne Spirt Orthopedic Yes
Dr. Daniel Redziniak Orthopedic Yes
Client wishes to evaluate Medigap coverage as well as Medicare Advantage plans
Prescription Drugs
Current refill schedule: Monthly
Pharmacy: Broadneck Pharmacy
5
