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 |
|---|---|---|---|---|---|---|
| PAP-INVEGA SUST 117/0.75 INJ 117/0.75 50458056201 · Rx 37028 |
— | 0.75 / 1 days | 0 of 0 | 2026-07-06 | 2026-07-07 | Completed |
| PAP-INVEGA SUST 117/0.75 INJ 117/0.75 50458056201 · Rx 37027 |
— | 0.75 / 1 days | 0 of 0 | 2026-07-06 | 2026-07-07 | Completed |
| DIVALPROEX 500MG ER TAB 500MG ER 55111053405 · Rx 32858 |
— | 56 / 28 days | 3 of 3 | 2023-12-11 | 2024-01-08 | Overdue |
| LISINOPRIL 10MG TAB 10MG 68180051401 · Rx 32846 |
— | 14 / 28 days | 3 of 3 | 2023-12-11 | 2024-01-08 | Overdue |
| HYDROXYZINE PAMOATE 50MG CAP 50MG 00185061505 · Rx 32845 |
— | 56 / 28 days | 3 of 3 | 2023-12-11 | 2024-01-08 | Overdue |
| ARIPIPRAZOLE 15MG TAB 15MG 13668021930 · Rx 32844 |
— | 28 / 28 days | 3 of 3 | 2023-12-11 | 2024-01-08 | Overdue |
| BUSPIRONE 10MG TAB 10MG 00093005401 · Rx 32843 |
— | 84 / 28 days | 3 of 3 | 2023-12-11 | 2024-01-08 | Overdue |
| TRAZODONE 150MG TAB 150MG 50111045002 · Rx 32842 |
— | 28 / 28 days | 3 of 3 | 2023-12-11 | 2024-01-08 | Overdue |
| PFIZER COVID BIVAL BSTR BA4/BA5 59267030402 · Rx 32847 |
— | 0.3 / 1 days | 0 of 0 | 2023-12-11 | 2023-12-12 | Completed |
| DRONABINOL 5MG CAP 5MG 00591359260 · Rx 32602 |
— | 60 / 30 days | 0 of 0 | 2023-10-04 | 2023-11-03 | Completed |
| METHOTREXATE 2.5MG TAB 2.5MG 67253032010 · Rx 32639 |
— | 3 / 3 days | 0 of 0 | 2023-10-11 | 2023-10-14 | Completed |
| HYDROCORT 0.5% CRE 0.5% 00168001431 · Rx 32517 |
test change for pro 3563 | 30 / 15 days | 0 of 0 | 2023-09-08 | 2023-09-23 | Completed |