Page 15 - Diane Peasley's Medicare Evaluation
P. 15
Client Data Sheet
Client ID: 6042147488 Rx Password Date: October 16, 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: 07/23/50
Date that Medicare became or will become primary (when client 01/01/18
has both Part A & Part B):
Client's home zip code: 98499
Has client started receiving Social Security or SSDI payments? Yes
After client retires, will he or she have access to health insurance No
through a spouse's or ex-spouse's employer plan?
Client's Selection Criteria
Does the Medicare
web site indicate that
Continue to see following physicians: this doctor accepts
assignment?
Dr. Rachel Dawson General practice Yes
Dr. Vinay Malhotra Cardiology Yes
Not independently
Dr. Chris Chen Oncology
listed
Dr. Dina Titova Rheumatology Yes
Client wants to compare Advantage plans and Medigap policies
Prescription Drugs
Current refill schedule: Mail order
Pharmacy: Walgreens
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