PA MEDI Screening Intake Form – Blair Senior Services

PA MEDI Screening Intake Form

PA MEDI Medicare Beneficiary Screening Intake Form

Step 1 of 4

Current Medical Providers
Primary Care Information
Primary Care Provider Practice Name & Location
Specialist Information
Specialist Practice Name & Location

Click the "+" to add another Specialist(up to 5)
Hospital Information
Hospital Location

Click the "+" to add another Hospital(up to 2)
Other Providers (Example: DME)
Provider Address

Click the "+" to add another Provider(up to 2)

List of Current Medications
Current Medications
Medication Name Doasge Frequency Type (Brand or Generic)

Click the "+" to add another Medication(up to 15)

Pharmacy Information
Current Pharmacy
Pharmacy Location
Is this your preferred pharmacy?
- Yes
- No
- I don't know
Are you open to using other pharmacies if your prescription costs are lower?
- Yes
- No
Notes
Email
This field is for validation purposes and should be left unchanged.

Blair Senior Services, Inc. serves residents of all ages through diverse programming and in Senior Centers in Blair County and surrounding areas.

Follow Us

1320 12th Avenue
Altoona, PA 16601
1-800-245-3282
814-946-1235
Monday - Friday
8 am - 4 pm

Blair Senior Services, Inc. helps local older adults live long, independent lives every day. You too can help an older adult remain at home today!

05/20/2021

Harrisburg, PA – The Pennsylvania Department of Aging today announced that older adults who will soon be turning 65 and are not yet enrolled in Medicare can attend a free virtual event to learn about their healthcare coverage options when enrolling for Medicare.

The "Welcome to Medicare" event on June 23, open from 3 p.m. to 7 p.m., will feature national presentations from the State Health Insurance Assistance Programs on Medicare eligibility, enrollment and coverage options. Representatives will be available to answer questions and assist older adults with information to enable them to make choices on Medicare coverage that best meets their needs and lowers their costs.

In Pennsylvania, this program is known as APPRISE. Throughout the national presentation, staff from APPRISE will host an exhibit for Pennsylvania and will respond to Medicare questions and provide information about the program. The Center for Advocacy for the Rights and Interests of the Elderly (CARIE) – Pennsylvania's Senior Medicare Patrol – also will join APPRISE to discuss Medicare fraud prevention.

"We encourage anyone who is turning 65 soon to join our Virtual Welcome to Medicare Fair. Pennsylvania's Medicare Counseling Program is here to help older adults learn about signing up and navigating the complexities of Medicare, avoiding late enrollment penalties, and preventing fraud," said Susan Neff, APPRISE director. "We also invite those who attend to visit the Pennsylvania-specific virtual exhibit at any time during the event. The APPRISE and CARIE staff look forward to chatting with seniors about their Medicare enrollment concerns."

Older adults can register for this event here

The APPRISE Program has nearly 800 trained counselors in the commonwealth who provide free, confidential, objective, and easy-to-understand information about original Medicare, Medicare Advantage Plans, prescription drug plans, and Medicare Supplement plans, and allows Medicare beneficiaries to compare plans and determine what best meets their needs and save them money.

To learn more about the APPRISE Program or becoming a volunteer, click here or call the APPRISE Helpline at 1-800-783-7067 .

MEDIA CONTACT: Jack Eilber, agingcomms@pa.gov

Close

Department Of Aging: June 23 Medicare Event Welcomes Future Beneficiaries With Information On Eligibility, Coverage Options