Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| AETNA | 02120212 | Secondary | |||
| 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 |
|---|---|---|---|---|---|---|
| INVEGA TRINZ 273MG INJ 273MG 50458060601 · Rx 31363 |
— | 0.87 / 90 days | 3 of 3 | 2022-08-02 | 2022-10-31 | Overdue |
| PROPRANOLOL 10MG TAB 10MG 50111046701 · Rx 24819 |
— | 84 / 28 days | 0 of 0 | 2013-01-10 | 2013-02-07 | Completed |
| PROPRANOLOL 10MG TAB 10MG 50111046701 · Rx 763 |
— | 84 / 28 days | 0 of 0 | 2008-06-27 | 2008-07-25 | Completed |