Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| PRIVATE | PR | 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 |
|---|---|---|---|---|---|---|
| LYRICA 50MG CAP 50MG 00071101368 · Rx 36530 |
— | 1 / 1 days | 0 of 5 | 2026-04-06 | 2026-04-07 | Completed |
| IBUPROFEN 100/5ML SUS 100/5ML 00472176094 · Rx 35823 |
— | 118 / 25 days | 1 of 1 | 2025-08-06 | 2025-08-31 | Overdue |
| DIVALPROEX 250MG DR TAB 250MG DR 57237004705 · Rx 35750 |
XFer To AAKASH PATEL @ ~~TEST:YAKIMA On 01-30-2026 From ACCESS PHARMAC | 90 / 30 days | 3 of 3 | 2025-07-31 | 2025-08-30 | Overdue |
| CALCIUM 600MG TAB 00536342608 · Rx 35749 |
XFer To AAKASH PATEL @ ~~TEST:YAKIMA On 01-30-2026 From ACCESS PHARMAC | 60 / 30 days | 3 of 3 | 2025-07-31 | 2025-08-30 | Overdue |
| VIMPAT 50MG TAB 50MG 00131247735 · Rx 35748 |
XFer To AAKASH PATEL @ ~~TEST:YAKIMA On 01-30-2026 From ACCESS PHARMAC | 30 / 30 days | 1 of 1 | 2025-07-31 | 2025-08-30 | Overdue |
| ALPRAZOLAM 2MG ER TAB 2MG ER 65162081206 · Rx 35747 |
XFer To AAKASH PATEL @ ~~TEST:YAKIMA On 01-30-2026 From ACCESS PHARMAC | 30 / 30 days | 2 of 2 | 2025-07-31 | 2025-08-30 | Overdue |
| MAPAP 160/5ML ELX 160/5ML 00904198520 · Rx 35822 |
— | 118 / 10 days | 1 of 1 | 2025-08-06 | 2025-08-16 | Overdue |
| APAP/CODEINE 300-30MG TAB 300-30MG 00093015001 · Rx 35746 |
XFer To AAKASH PATEL @ ~~TEST:YAKIMA On 01-30-2026 From ACCESS PHARMAC | 10 / 1 days | 0 of 0 | 2025-07-31 | 2025-08-01 | Completed |
| PSB SYNTHETIC PRODUCT 00093015001 · Rx 35746 |
XFer To AAKASH PATEL @ ~~TEST:YAKIMA On 01-30-2026 From ACCESS PHARMAC | 10 / 1 days | 0 of 0 | 2025-07-31 | 2025-08-01 | Completed |
| GABAPENTIN 100MG CAP-APS 100MG 67877022201 · Rx 35473 |
— | 30 / 30 days | 0 of 0 | 2025-06-24 | 2025-07-24 | Completed |
| DIVALPROEX 250MG DR TAB 250MG DR 57237004705 · Rx 35472 |
— | 90 / 30 days | 3 of 3 | 2025-06-24 | 2025-07-24 | Overdue |
| CALCIUM 600MG TAB 600MG 37864073099 · Rx 35471 |
— | 60 / 30 days | 3 of 3 | 2025-06-24 | 2025-07-24 | Overdue |
| VIMPAT 50MG TAB 50MG 00131247735 · Rx 35470 |
— | 30 / 30 days | 1 of 1 | 2025-06-24 | 2025-07-24 | Overdue |
| ALPRAZOLAM 2MG ER TAB 2MG ER 65162081206 · Rx 35469 |
— | 30 / 30 days | 2 of 2 | 2025-06-24 | 2025-07-24 | Overdue |
| VYVANSE 30MG CAP 30MG 59417010310 · Rx 35467 |
— | 30 / 30 days | 0 of 0 | 2025-06-24 | 2025-07-24 | Completed |
| WARFARIN 10MG TAB 10MG 00555083502 · Rx 35545 |
XFer To AAKASH PATEL @ ~~TEST:YAKIMA On 01-30-2026 From ACCESS PHARMAC | 7 / 7 days | 0 of 0 | 2025-07-03 | 2025-07-10 | Completed |
| WARFARIN 10MG TAB 10MG 68382005901 · Rx 35544 |
— | 7 / 7 days | 3 of 3 | 2025-07-03 | 2025-07-10 | Overdue |
| APAP/CODEINE 300-30MG TAB 300-30MG 00093015001 · Rx 35468 |
— | 10 / 1 days | 0 of 0 | 2025-06-24 | 2025-06-25 | Completed |
| PSB SYNTHETIC PRODUCT 00093015001 · Rx 35468 |
— | 10 / 1 days | 0 of 0 | 2025-06-24 | 2025-06-25 | Completed |