Page 15 - Cover Letter and Medicare Evaluation for Mrs. Jane Miller
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Client Data Sheet
Client ID: 63021245 Rx Password Date: July 1, 2021
Please verify the accuracy of the information below and let us know if
To the Client:
changes need to be made.
Client's DOB: 05/05/55
Date that Medicare became or will become primary (when client
has both Part A & Part B): 09/01/21
Client's home zip code: 19810
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
Continue to see following physicians:
Chen, Maria Fang-Chun Neurologist
DeGroot, Kenneth Chiropractic
Denstman, Fred Colorectal
Mullins, Dr. Sarah Primary Care
Sheppard, William Ear, Nose & Throat
Client would like to see comparisons of both types of coverage
Prescription Drugs
Current refill schedule: Client does not currently take Rx drugs
Pharmacy: CVS
