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 |
|---|---|---|---|---|---|---|
| GOOD & PLENTY PINK 98765432101 · Rx 648 |
— | 28 / 28 days | 0 of 1 | 2008-02-05 | 2008-03-04 | Completed |
| 32165498701 32165498701 · Rx 652 |
— | 30 / 30 days | 11 of 11 | 2008-01-16 | 2008-02-15 | Overdue |
| 04142012215 04142012215 · Rx 653 |
— | 84 / 28 days | 0 of 0 | 2008-01-16 | 2008-02-13 | Completed |
| 65498732101 65498732101 · Rx 651 |
— | 84 / 28 days | 0 of 0 | 2008-01-16 | 2008-02-13 | Completed |
| 78945612301 78945612301 · Rx 650 |
— | 28 / 28 days | 0 of 0 | 2008-01-16 | 2008-02-13 | Completed |
| FLUTICASONE 0.005%/EUCERIN 1:1 0.005% 12345678900 · Rx 649 |
— | 56 / 28 days | 0 of 0 | 2008-01-16 | 2008-02-13 | Completed |
| CITALOPRAM 10MG TAB 10MG 00172474060 · Rx 108 |
— | 30 / 30 days | 0 of 0 | 2006-09-12 | 2006-10-12 | Completed |
| RISPERDAL CONSTA 50MG INJ 50MG 50458030811 · Rx 107 |
— | 1 / 14 days | 0 of 0 | 2006-09-12 | 2006-09-26 | Completed |