Page 17 - Cover Letter and Evaluation for Patricia Stelter -- PDF version
P. 17
Client Data Sheet
Client ID: 11419227 October 22, 2020
Please verify the accuracy of the information below and let us know if changes need to
be made.
Client's DOB: 12/29/55
Date that Medicare became or will become primary (when
client has both Part A & Part B): 12/01/20
Client's home zip code: 60451
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 wants to compare both types of coverage
Prescription Drugs Client's pharmacy: CVS
Refill Schedule: Monthly
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