Page 21 - Cover Letter and Evaluation for Patricia Hendrickson
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Client Data Sheet
Client ID: 9415530112 Rx Password Date: January 30, 2018
Please verify the accuracy of the information below and let us know if
To the Client:
changes need to be made.
Client's DOB: 08/12/54
Date that Medicare became or will become primary (when client
has both Part A & Part B): TBD
Client's home zip code: 08502
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? NA
Client's Selection Criteria
Does the Medicare
web site indicate that
Continue to see following physicians: this doctor accepts
assignment?
Dr. Jason Hollander Endocrinogy Yes
Dr. Anne Swedlund Gastroenterology Yes
Dr. Samuel Liu Opthalmology Yes
Dr. Kenneth Ung Gynecology Yes
Dr. Joseph Pecora Primary Care Yes
Client wishes to compare employer retiree plan to standard Medicare options
Prescription Drugs
Refill schedule: Mail-Order
Local pharmacy: Walgreens
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