Page 15 - Cover Letter and Evaluation for Susan Marx
P. 15
Client Data Sheet
Client ID: 319144 March 20, 2020
Please verify the accuracy of the information below
Client's DOB: 03/19/54
Date that Medicare became or will become primary (when
client has both Part A & Part B): 05/01/20
Client's home zip code: 15206
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
this doctor accepts
Continue to see following physicians:
Medicare-approved
rates?
Dr. Alexander Anetakis Opthalmology Yes
Dr. Tarek Shazly Opthalmology Yes
Dr. Terence Starz Rheumatology Yes
Client wishes to compare both types of supplemental coverage
Prescription Drugs
Local Pharmacy Rite Aid
Preferred refill schedule Mail Order
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