Page 13 - Cover Letter and evaluation for Katherine Kensky
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Client Data Sheet
Client ID: 1571806240 Rx Password Date: November 10, 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: 11/17/52
Date that Medicare became or will become primary (when client
has both Part A & Part B): 01/01/18
Client's home zip code: 31411
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's Selection Criteria
Does the Medicare
web site indicate that
Continue to see following physicians: this doctor accepts
assignment?
Dr. Dana Jacques Ob/Gyn Yes
Dr. David Patella Primary Care Yes
Client wishes to evaluate Medigap policies
Prescription Drugs
Refill Schedule: Monthly (retail)
Pharmacy: Belair (in Sacramento area)
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