Page 19 - Cover Letter and Medicare Evaluation for Vic Bosiger
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Client Data Sheet
Client ID: 63021245 Rx Password Date: October 11, 2021
Please verify the accuracy of the information below and let us know if
To the Client:
changes need to be made.
Client's DOB: 07/22/53
Date that Medicare became or will become primary (when client
has both Part A & Part B): 01/01/22
Client's home zip code: 24551
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
Continue to see following physicians:
Dr. David Paulus Family practice
Client wishes to enroll in Medicare Advantage plan
Prescription Drugs
Current refill schedule: Monthly
Pharmacy: CVS
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