Page 13 - Cover Letter and Evaluation for Gary Caskey
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Client Data Sheet
Client ID: 5559764256 Rx Password Date: April 10, 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: 01/22/83
Date that Medicare became or will become primary (when client 06/01/18
has both Part A & Part B):
Client's home zip code: 30338
Has client started receiving Social Security or SSDI payments? Yes
After client retires, will he or she have access to health insurance No
through a spouse's or ex-spouse's employer plan?
Client's Selection Criteria
Does the Medicare
web site indicate that
Continue to see following physicians: this doctor accepts
assignment?
Dr. Nicholas Boulis Neurosurgery Yes
Dr. James Kinahan Internal medicine Yes
Dr. David Robertson Endocrinology Yes
Dr. Ramon Sanchez Neurology Yes
Dr. Tina Thomas Nephrologist Yes
Dr. John Patrick Waring Gastroenterology Yes
Client is interested only in Medigap policies
Prescription Drugs
Refill Schedule: Monthly refills
CVS
5
