Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| ADVANCE/PCS 8 | Secondary | ||||
| 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 |
|---|---|---|---|---|---|---|
| LITHIUM CARB ER 450MG TAB 450MG ER 00054002025 · Rx 33595 |
— | 30 / 30 days | 3 of 3 | 2024-06-12 | 2024-07-12 | Overdue |
| ZOLPIDEM 10MG TAB 10MG 13668000801 · Rx 33594 |
— | 30 / 30 days | 3 of 3 | 2024-06-12 | 2024-07-12 | Overdue |
| LATUDA 60MG TAB 60MG 63402030630 · Rx 33593 |
— | 30 / 30 days | 0 of 0 | 2024-06-12 | 2024-07-12 | Completed |
| LITHIUM CARB 300MG ER TAB 300MG ER 00054002129 · Rx 33592 |
— | 60 / 30 days | 3 of 3 | 2024-06-12 | 2024-07-12 | Overdue |
| HYDROCHLOROT 25MG TAB 25MG 23155000810 · Rx 33591 |
— | 30 / 30 days | 5 of 10 | 2024-06-12 | 2024-07-12 | Overdue |
| VALSARTAN 40MG TAB 40MG 43547036703 · Rx 33590 |
— | 30 / 30 days | 1 of 6 | 2024-06-12 | 2024-07-12 | Overdue |
| METFORMIN 500MG ER TAB 500MG ER 67877015901 · Rx 33589 |
— | 60 / 30 days | 4 of 6 | 2024-06-12 | 2024-07-12 | Overdue |
| AMITRIPTYLIN 25MG TAB 25MG 00781148701 · Rx 33588 |
— | 30 / 30 days | 0 of 0 | 2024-06-12 | 2024-07-12 | Completed |
| LORATADINE 10MG TAB 10MG 45802065087 · Rx 33587 |
— | 30 / 30 days | 0 of 0 | 2024-06-12 | 2024-07-12 | Completed |