Page 17 - Cover Letter and Evaluation for Debbie Workman
P. 17
Client Data Sheet
Client ID: 2065979904 Rx Password Date: December 14, 2017
Please verify the accuracy of the information below and let us know if
To the Client:
changes need to be made.
Client's DOB: 02/20/53
Date that Medicare became or will become primary (when client
has both Part A & Part B): 02/01/18
Client's home zip code: 99206
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
Continue to see following physicians: this doctor accepts
assignment?
Kevin Bichler, PA No
Client would like to see comparisons of both types of coverage
Client willing to consider other physicians, including ones in
Providence Medical Group
Prescription Drugs
Current refill schedule: Mail order
Pharmacy: Walgreens
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