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 |
|---|---|---|---|---|---|---|
| ACETAMIN 500MG TAB 500MG 00182845389 · Rx 36268 |
— | 30 / 30 days | 3 of 3 | 2025-12-03 | 2026-01-02 | Overdue |
| ACETAMIN 325MG TAB 325MG 63739044001 · Rx 36267 |
— | 30 / 30 days | 4 of 4 | 2025-12-03 | 2026-01-02 | Overdue |
| ACETAMIN 325MG TAB 325MG 51111048893 · Rx 36336 |
— | 1 / 1 days | 99 of 99 | 2025-12-24 | 2025-12-25 | Overdue |
| NAPROXEN 220MG TAB 220MG 00904523059 · Rx 36335 |
— | 1 / 1 days | 0 of 0 | 2025-12-24 | 2025-12-25 | Completed |
| VERAPAMIL 120MG TAB 120MG 00378077201 · Rx 34285 |
— | 7 / 7 days | 2 of 3 | 2024-11-05 | 2024-11-12 | Overdue |
| STRATTERA 100MG CAP 100MG 00002325130 · Rx 34282 |
— | 7 / 7 days | 2 of 3 | 2024-11-05 | 2024-11-12 | Overdue |
| XYZAL 5MG TAB 5MG 00024580090 · Rx 34281 |
— | 7 / 7 days | 2 of 3 | 2024-11-05 | 2024-11-12 | Overdue |