Page 11 - Cover letter and Medicare evaluation for Hans Burkhardt
P. 11
Client Data Sheet
Client ID: 63021242 Rx Password Date: September 14, 2021
Please verify the accuracy of the information below and let us know if
To the Client:
changes need to be made.
Client's DOB: 05/25/55
Date that Medicare became or will become primary (when client
has both Part A & Part B): 09/01/21
Client's home zip code: 94544
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
Client does not currently see any physicians
Client wants to get a Medigap policy and stand-alone drug plan,
which will provide him coverage if he moves to another part of
the U.S.
Prescription Drugs
Client does not currently take any Rx drugs
Client uses Walgreens Pharmacy
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