Page 17 - Cover Letter & Evaluation for Patricia Letizia
P. 17
Client Data Sheet
Client ID: 5933054208 Rx Password Date: October 15, 2019
Please verify the accuracy of the information below and let us
To the Client:
know if changes need to be made.
Client's DOB: 04/15/26
Date that Medicare became or will become primary (when client has
both Part A & Part B): Already in place
Client's home zip code: 61615 and 53151
Has client started receiving Social Security or SSDI payments? Yes
Does client have access to health insurance through a spouse's or ex-
spouse's employer plan? No
Client's Selection Criteria Listed network affiliations*
Aetna Medicare Network Health
List of preferred physicians in Wisconsin
Premier Plan (PPO) Medicare Go (PPO)
Dr. Renee Sinopoli Family practice Yes Yes
Dr. Heather Wells-Holtey Dermatology Yes Yes
Dr. Robert Roth Cardiology Yes Yes
Dr. Uma Thirumakizhmaran Internal Medicine No No
*Before enrolling in a plan, verify that doctors are still in network
Client wishes to compare her present coverage to Wisconsin options
Prescription Drugs
Current refill schedule: Monthly
Pharmacy: CVS Pharmacy
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