Page 15 - Cover Letter and Evaluation for Gary Janke
P. 15
Client Data Sheet
Client ID: 2912465408 Rx Password Date: October 8, 2018
Please verify the accuracy of the information below and let us know
To the Client:
if changes need to be made.
1500 1275 11/15/48
Date that Medicare became or will become primary (when
client has both Part A & Part B): 01/01/19
Client's home zip code: 37024
Has client started receiving Social Security or SSDI No
payments?
After client retires, will he or she have access to health
insurance through a spouse's or ex-spouse's employer No
plan?
Client's Selection Criteria
Does the Medicare
web site indicate
Continue to see following physicians: that this doctor
accepts assignment?
Sean Ryan Internal medicine Yes
Client would like to see comparisons of both types of coverage
Prescription Drugs
Refill schedule: Mail Order
Pharmacy: Walgreens
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