Page 15 - Cover Letter and Medicare Evaluation for Michael Bichy
P. 15
Client Data Sheet
Client ID: 19970x5 Rx Password Date: November 7, 2022
To the Client:
Client's DOB: 08/27/51
Date that Medicare became or will become primary (when client
has both Part A & Part B): Already in effect
Client's home zip code: 19970
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
Does this provider
accept Medicare-
Continue to see following physicians:
approved rates?
Dr. John Pare, primary care Yes
Dr. James Cherry, urology Yes
Dr. Edmund Carroll, orthopedic surgery Yes
Prescription Drugs
Current Refill Schedule: Monthly
Pharmacy: Rite Aid
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