Page 15 - Cover Letter and Evaluation for John
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Client Data Sheet
Client ID: 3199691584 Rx Password Date: October 10, 2018
Please verify the accuracy of the information below and let us know if
To the Client:
changes need to be made.
Client's DOB: 11/03/53
Date that Medicare became or will become primary (when client
has both Part A & Part B): 11/01/18
Client's home zip code: 92586
Has client started receiving Social Security or SSDI payments? NA
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?
Cardiac
Dr. Douglas Gibson Yes
electrophysiology
Dr. Andrea Natale Cardiology May accept
Dr. Michael Truong Endocrinology Yes
Client wishes to evaluate Medigap coverage as well as Medicare Advantage plans
Prescription Drugs
Current refill schedule: NA
Pharmacy: NA
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