Page 11 - Cover letter and evaluation for Paulina Rosenstein
P. 11

Client Data Sheet

Client ID: 411788                                    Rx Password Date: January 16, 2018

To the Client:  Please verify the accuracy of the information below and let us know if
                                          changes need to be made.

                                                                Client's DOB:  01/02/53
Date that Medicare became or will become primary (when client                  02/01/18

                                                has both Part A & Part B):      10031
                                                   Client's home zip code:         No

    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?

Client's Selection Criteria                                                     Does the Medicare
              Continue to see following physicians:                            web site indicate that

                                                                                this doctor accepts
                                                                                    assignment?

     Client is interested only in Medigap policies

Prescription Drugs
                        Client will have Rx drug coverage through her
                        currently working husband's employer plan

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