Page 15 - Cover Letter and Evaluation for Anne Ellzey
P. 15
Client Data Sheet
Client ID: 3608244448 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: 12/07/52
Date that Medicare became or will become primary (when client
has both Part A & Part B): 12/01/17
Client's home zip code: 78704
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. Rajat Gupta Neurologist Yes
Dr. Bharati Kolte Internist Yes
Dr. Kelly Martinez Oncologist Does not indicate
Dr. Ai Mukai Pain medicine Yes
Dr. Debra Ann Pratt Oncologist Yes
Dr. Mona Lin Ridgeway Gastroenterologist Yes
Dr. Christine Warmann Psychiatrist Does not indicate
Client wishes to evaluate Medigap policies
Prescription Drugs
Refill Schedule: Retail as well as mail-order
Pharmacy: HEB
5
