Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| PRIVATE | PR | Secondary | |||
| RELAY TEST PLAN COPAY | Secondary | ||||
| RELAY TEST PLAN | 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 |
|---|---|---|---|---|---|---|
| MAPAP ARTHRITIS 650MG TAB 650MG 00904576960 · Rx 36162 |
— | 7 / 7 days | 3 of 3 | 2025-11-19 | 2025-11-26 | Overdue |
| MELOXICAM 15MG TAB 15MG 69097015907 · Rx 36161 |
— | 7 / 7 days | 3 of 3 | 2025-11-19 | 2025-11-26 | Overdue |
| JTEST-TRAZODONE 50MG TAB 50MG 50111043303 · Rx 32296 |
— | 28 / 28 days | 0 of 0 | 2023-07-21 | 2023-08-18 | Completed |