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 |
|---|---|---|---|---|---|---|
| ASA LOW DOSE 81MG EC TAB 81MG EC 00603002622 · Rx 20451 |
— | 30 / 30 days | 0 of 0 | 2011-03-10 | 2011-04-09 | Completed |
| PAP-ZYPREXA 10MG TAB 10MG 00002411730 · Rx 20450 |
— | 90 / 30 days | 0 of 0 | 2011-03-10 | 2011-04-09 | Completed |
| ALBUTEROL 90MCG AER 90MCG 62037079444 · Rx 20452 |
— | 17 / 20 days | 0 of 0 | 2011-03-10 | 2011-03-30 | Completed |