Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| PRIVATE | PR | Secondary |
PSB F6 E1 · Manual exception
Routine B1 processing uses active coverage already on file and does not call E1. Use this manual check only when eligibility is uncertain. Results are coverage proposals; applying coverage remains a separate user decision.
| Result | Mode | Actor | Response | Recorded |
|---|---|---|---|---|
| No E1 eligibility evidence recorded. | ||||
| Medication | Sig | Qty / days supply | Refills remaining | Last fill | Next due | Status |
|---|---|---|---|---|---|---|
| PREMARIN 0.625MG TAB 0.625MG 00046110281 · Rx 765 |
— | 28 / 28 days | 0 of 1 | 2009-02-02 | 2009-03-02 | Completed |
| PREMARIN 0.3MG TAB 0.3MG 00046086881 · Rx 456 |
— | 30 / 30 days | 0 of 0 | 2007-03-08 | 2007-04-07 | Completed |