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 |
|---|---|---|---|---|---|---|
| MODERNA COVID BIVAL BSTR 0.5ML BA4/BA5 80777028299 · Rx 34952 |
— | 0.5 / 1 days | 0 of 0 | 2025-03-06 | 2025-03-07 | Completed |
| PFIZER COVID BIVAL BSTR BA4/BA5 59267030402 · Rx 34951 |
— | 0.3 / 1 days | 0 of 0 | 2025-03-06 | 2025-03-07 | Completed |
| FLUAD QUADRI 2023-24 INJ 2023-24 70461012303 · Rx 34950 |
— | 0.5 / 1 days | 0 of 0 | 2025-03-06 | 2025-03-07 | Completed |
| MODERNA COVID BIVAL BSTR 0.5ML BA4/BA5 80777028299 · Rx 34949 |
— | 0.5 / 1 days | 0 of 0 | 2025-03-06 | 2025-03-07 | Completed |
| MODERNA COVID BIVAL BSTR 0.5ML BA4/BA5 80777028299 · Rx 34948 |
— | 0.5 / 1 days | 0 of 0 | 2025-03-06 | 2025-03-07 | Completed |
| MODERNA COVID BIVAL BSTR 0.5ML BA4/BA5 80777028299 · Rx 34947 |
— | 0.5 / 1 days | 0 of 0 | 2025-03-06 | 2025-03-07 | Completed |
| FLUAD QUADRIVALENT 0.5ML SYR 70461012103 · Rx 34946 |
— | 0.5 / 1 days | 0 of 0 | 2025-03-06 | 2025-03-07 | Completed |
| FLUAD 2024-25 INJ 2024-25 70461002404 · Rx 34945 |
— | 0.5 / 1 days | 0 of 0 | 2025-03-06 | 2025-03-07 | Completed |