Page 15 - Cover letter and evaluation for Darlene Hoover
P. 15
Client Data Sheet
Client ID: 925477823 Rx Password Date: November 8, 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: 06/08/49
Date that Medicare became or will become primary (when
client has both Part A & Part B): 01/01/19
Client's home zip code: 46845
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? Yes
Client's Selection Criteria Does the Medicare
web site indicate
that this doctor
Continue to see following physicians:
accepts Medicare-
approved rates?
Dr. Gerald A. Kelty Family medicine Yes
Dr. Virendra Parikh Surgery Yes
Dr. Thomas Lorenc Ob/Gyn Yes
Client would like to see comparisons of both types of coverage
Prescription Drugs
Refill schedule: Monthly
Pharmacy: CVS
5
