Page 13 - Cover Letter and Evaluation for Paul Dorroh
P. 13
Client Data Sheet
Client ID: 141618x Rx Password Date: April 16, 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: 05/12/52
Date that Medicare became or will become primary (when client
has both Part A & Part B): 05/01/18
Client's home zip code: 30002
Has client started receiving Social Security or SSDI payments? Will start May 1
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. Julie Kim Internal medicine Yes
Dr. Jessica Shantha Opthalmology Yes
Client would like to see comparisons of both types of coverage
Prescription Drugs
Current refill schedule: NA
Pharmacy: Walgreens
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