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 65162081206 · Rx 35662 |
— | 30 / 30 days | 2 of 2 | 2025-07-17 | 2025-08-16 | Overdue |
| VYVANSE 30MG CAP 30MG 59417010310 · Rx 35660 |
— | 30 / 30 days | 0 of 0 | 2025-07-17 | 2025-08-16 | Completed |
| APAP/CODEINE 300-30MG TAB 300-30MG 00093015001 · Rx 35661 |
— | 10 / 1 days | 0 of 0 | 2025-07-17 | 2025-07-18 | Completed |
| PSB SYNTHETIC PRODUCT 00093015001 · Rx 35661 |
— | 10 / 1 days | 0 of 0 | 2025-07-17 | 2025-07-18 | Completed |
| PENICILLN VK 125/5ML SOL 125/5ML 00781612046 · Rx 34019 |
— | 15 / 15 days | 0 of 0 | 2024-09-04 | 2024-09-19 | Completed |
| IBUPROFEN 100/5ML SUS 100/5ML 45802095243 · Rx 34018 |
— | 30 / 15 days | 0 of 0 | 2024-09-04 | 2024-09-19 | Completed |