Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| PRIVATE | PR | Secondary | |||
| YESSICA'S TEST OPEN ITEM | 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 |
|---|---|---|---|---|---|---|
| VERAPAMIL 100MG ER CAP-APS 100MG ER 00378620101 · Rx 37041 |
— | 1 / 1 days | 0 of 0 | 2026-07-13 | 2026-07-14 | Completed |
| JOLESSA TAB 00555912366 · Rx 36537 |
— | 28 / 28 days | 1 of 1 | 2026-03-13 | 2026-04-10 | Overdue |
| BUPROPN HCL 150MG XL TAB 150MG XL 68180031906 · Rx 35219 |
— | 7 / 7 days | 3 of 3 | 2025-05-08 | 2025-05-15 | Overdue |
| GABAPENTIN 600MG TAB 600MG 16714033001 · Rx 35218 |
— | 7 / 7 days | 3 of 3 | 2025-05-08 | 2025-05-15 | Overdue |
| TESSALON PER 100MG CAP 100MG 00069012201 · Rx 34714 |
— | 15 / 5 days | 3 of 3 | 2025-02-04 | 2025-02-09 | Overdue |
| TRAZODONE 150MG TAB 150MG 60505265501 · Rx 33311 |
— | 30 / 30 days | 3 of 3 | 2024-04-11 | 2024-05-11 | Overdue |
| FLUAD QUADRI 2023-24 INJ 2023-24 70461012303 · Rx 33056 |
— | 0.5 / 1 days | 0 of 0 | 2024-02-09 | 2024-02-10 | Completed |
| FLUCELVAX QUAD MD 17-18 10DS 2017-2018 70461020102 · Rx 33055 |
— | 0.5 / 1 days | 0 of 0 | 2024-02-09 | 2024-02-10 | Completed |