Page 13 - Cover Letter and evaluation for Paul J. Lingane
P. 13
Client Data Sheet
Client ID: 2429701 Rx Password Date: September 15, 2017
Please verify the accuracy of the information below and let us know if
To the Client:
changes need to be made.
Client's DOB: 11/24/52
Date that Medicare became or will become primary (when client
has both Part A & Part B): 11/01/17
Client's home zip code: 94062
Has client started receiving Social Security or SSDI payments? No
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. John Jay Jernick Primary Care Yes
Dr. Geoffrey Sonn Urology Yes
Client wishes to evaluate Medigap coverage as well as Medicare Advantage plans
Prescription Drugs
Refill Schedule: NA
Pharmacy: Walgreens
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