Page 13 - Cover Letter and Evaluation for Fred Heald
P. 13
Client Data Sheet
Client ID: 11430b February 14, 2020
Please verify the accuracy of the information below and let us know if changes need to
be made.
Client's DOB: 06/01/55
Date that Medicare became or will become primary (when
client has both Part A & Part B): 05/01/20
Client's home zip code: 34108
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 wants a Medigap policy + stand-alone drug plan for
supplemental medical coverage
Prescription Drugs Client's pharmacy: Walgreens
Refill Schedule: Monthly
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