Page 13 - Cover Letter and Evaluation for Barbara Lesswing
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Client Data Sheet
Client ID: 1026286272 Rx Password Date: November 20, 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: 07/24/43
Date that Medicare became or will become primary (when client
has both Part A & Part B): Some time ago
Client's home zip code: 14031
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. Ajay Chaudhuri Endocrinologist Yes
Dr. Thomas Kaminska Opthalmologist Yes
Dr. Mary Lenahan Dermatologist Yes
Dr. Joseph Maddi Cardiologist Yes
Dr. Stephen Mechtler Ob/Gyn Yes
Dr. Paul Nasca Podiatrist Yes
Dr. Keith Stube Orthopedist Yes
Client wishes to evaluate her current Medicare Advantage Plan --
the Independent Health Association Encompass 65 Basic HMO
Prescription Drugs Current refill schedule: Monthly
Pharmacy: Rite-Aid
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