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 |
|---|---|---|---|---|---|---|
| ALPRAZOLAM 2MG ER TAB 2MG ER 00228308706 · Rx 35943 |
— | 30 / 30 days | 2 of 2 | 2025-09-12 | 2025-10-12 | Overdue |
| VYVANSE 30MG CAP 30MG 59417010310 · Rx 35941 |
— | 3 / 30 days | 0 of 0 | 2025-09-12 | 2025-10-12 | Completed |
| AZITHROMYCIN 250MG TAB 250MG 00781149668 · Rx 35940 |
— | 6 / 5 days | 0 of 0 | 2025-09-12 | 2025-09-17 | Completed |
| NAPROXEN 500MG TAB 500MG 00143134801 · Rx 35939 |
— | 10 / 5 days | 3 of 3 | 2025-09-12 | 2025-09-17 | Overdue |
| APAP/CODEINE 300-30MG TAB 300-30MG 00093015001 · Rx 35942 |
— | 10 / 1 days | 0 of 0 | 2025-09-12 | 2025-09-13 | Completed |
| PSB SYNTHETIC PRODUCT 00093015001 · Rx 35942 |
— | 10 / 1 days | 0 of 0 | 2025-09-12 | 2025-09-13 | Completed |
| FLONASE ALGY 50MCG SPR 50MCG 00135057603 · Rx 33443 |
— | 28 / 28 days | 0 of 1 | 2025-08-01 | 2025-08-29 | Completed |
| NAPROXEN 500MG TAB 500MG 68462019001 · Rx 35229 |
— | 10 / 5 days | 2 of 3 | 2025-05-29 | 2025-06-03 | Overdue |
| MUCINEX 600MG ER TAB 600MG ER 63824000834 · Rx 35231 |
— | 10 / 5 days | 0 of 0 | 2025-05-09 | 2025-05-14 | Completed |
| AZITHROMYCIN PAK 250MG #6 250MG 50111078766 · Rx 35230 |
— | 6 / 5 days | 0 of 0 | 2025-05-09 | 2025-05-14 | Completed |
| TYLENOL ARTH 650MG TAB 650MG 50580011210 · Rx 33444 |
— | 28 / 14 days | 2 of 3 | 2025-02-07 | 2025-02-21 | Overdue |
| BUPREN/NALOX 2-0.5MG SUB 2-0.5MG 65162041603 · Rx 34776 |
— | 1 / 1 days | 3 of 3 | 2025-02-07 | 2025-02-08 | Overdue |