Page 15 - Evaluation and cover letter for Jack Barnhill
P. 15
Client Data Sheet
Client ID: 9671121888 Rx Password Date: December 6, 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: 08/17/49
Date that Medicare became or will become primary (when client
has both Part A & Part B): 01/01/18
Client's home zip code: 92691
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 the Medicare
web site indicate that
Continue to see following physicians: this doctor accepts
assignment?
Dr. Craig Albert Primary care Yes
Dr. Hitesh Patel Neurology Yes
Client would like to see comparisons of both types of coverage
Prescription Drugs
Current refill schedule: Monthly
Pharmacy: CVS/Target
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