Get Part D Information Sheet (1 Sheet For Each Client)

Filling out the Part D Information Sheet is essential for obtaining a personalized report on your Medicare drug plan options. This guide will take you through the process of completing the form online step-by-step, ensuring a smooth experience.

Follow the steps to accurately fill out the form online.

1. Click 'Get Form' button to obtain the Part D Information Sheet and open it in your preferred editing tool.
2. In the Client Full Name field, enter the complete name of the individual for whom you are completing the form.
3. Add the Medicare number in the specified field to ensure proper identification.
4. Fill in the individual's address, making sure to include all relevant details such as street, city, state, and ZIP code.
5. Provide a contact phone number for any follow-up inquiries.
6. Enter the birth date of the individual using the appropriate format.
7. Indicate the Medicare Part A effective date in the specified field.
8. List the name of any current supplemental medical plan that the individual may have.
9. Enter the name of the current Medicare Part D plan, if applicable.
10. Provide the pharmacy name where prescriptions are usually filled.
11. For prescription information, list each prescription name, its frequency, and dosage. If additional space is needed, utilize the back of the form.
12. Indicate whether you approve the substitution of an available generic equivalent for any brand-name drugs by circling 'Yes' or 'No.'
13. Once all fields are completed, review the information for accuracy.
14. Save your changes to ensure all entered information is stored.
15. You can download, print, or share the completed form as necessary before submission.

Complete your Part D Information Sheet online today for personalized Medicare plan results.