Page 15 - Cover letter and evaluation for John Johnson
P. 15
Client Data Sheet
Client ID: 6387086592 December 27, 2018
Please verify the accuracy of the information below
Client's DOB: 04/06/54
Date that Medicare became or will become primary (when client
has both Part A & Part B): 04/01/19
Client's home zip code: 76034
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
this doctor accepts
Continue to see following physicians:
Medicare-approved
rates?
Dr. Marc Chapman Internal Medicine Yes
Dr. Richard Chatfield Chiropractor Yes
Dr. Douglas Farris Dermatology Yes
Dr. James Gonzales Ear, Nose, Throat Yes
Dr. Gordon Luk Gastroenterology Yes
Dr. Mark Muller Orthopedics Yes
Dr. Christopher Pace Urology Yes
Dr. Norman Slusher Ophthalmology Yes
Dr. Alisa Thamwiwat Cardiology Yes
Dr. Sven Wust Allergist Yes
Client wishes to compare both types of supplemental coverage
Prescription Drugs
Pharmacy CVS
Refill schedule Mail Order
5
