Page 15 - Cover Letter & Evaluation for Isaac Kapon
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Client Data Sheet
Client ID: 10052017 Rx Password Date: October 5, 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: 11/15/52
Date that Medicare became or will become primary (when client
has both Part A & Part B): 11/01/17
Client's home zip code: 89014
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?
Dr. Thomas Alfreda, Jr Internal medicine Yes
Dr. Steven Thomas Orthopedic surgery Yes
Dr. Jacques Lamothe Cardiology Yes
Dr. Francis Teng Bariatric surgery Yes
Client wants to compare PPO plans and Medigap policies (but not HMO's)
Prescription Drugs
Current refill schedule: NA
Pharmacy: CVS, Walgreens, or Walmart
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