Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| IVAX INDIGENT PROGRAM | 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 |
|---|---|---|---|---|---|---|
| ORANGE CANDY 62580000000 · Rx 28398 |
— | 60 / 30 days | 2 of 2 | 2017-01-04 | 2017-02-03 | Overdue |
| RISPERDAL 3MG TAB 3MG 50458033006 · Rx 25997 |
— | 60 / 30 days | 5 of 5 | 2014-05-09 | 2014-06-08 | Overdue |
| VITAMIN C 500MG TAB 500MG 00904052360 · Rx 24796 |
— | 120 / 30 days | 0 of 0 | 2012-12-20 | 2013-01-19 | Completed |
| FISH OIL 1000MG CAP 1000MG 00904404360 · Rx 24795 |
— | 60 / 30 days | 0 of 0 | 2012-12-20 | 2013-01-19 | Completed |
| IBANDRONATE 150MG TAB 150MG 55111057503 · Rx 24798 |
— | 1 / 28 days | 0 of 0 | 2012-12-20 | 2013-01-17 | Completed |
| VITAMIN D 50000IU CAP 50000UNT 50111099001 · Rx 24797 |
— | 4 / 28 days | 0 of 0 | 2012-12-20 | 2013-01-17 | Completed |