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 |
|---|---|---|---|---|---|---|
| AUSTEDO 9MG TAB 9MG 68546017160 · Rx 29347 |
— | 30 / 30 days | 0 of 0 | 2018-02-12 | 2018-03-14 | Completed |
| TRASYLOL 10000KIU INJ 10000/ML 00026819636 · Rx 29346 |
— | 1 / 1 days | 1 of 1 | 2018-02-12 | 2018-02-13 | Overdue |