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 |
|---|---|---|---|---|---|---|
| TRAZODONE 150MG TAB 150MG 50111044102 · Rx 33542 |
— | 30 / 30 days | 3 of 3 | 2024-06-05 | 2024-07-05 | Overdue |
| CITALOPRAM 10MG TAB 10MG 00378623101 · Rx 33667 |
— | 1 / 1 days | 3 of 3 | 2024-07-02 | 2024-07-03 | Overdue |
| CITALOPRAM 40MG TAB 40MG 00378623301 · Rx 33541 |
— | 5 / 5 days | 3 of 3 | 2024-06-05 | 2024-06-10 | Overdue |
| CITALOPRAM 20MG TAB 20MG 00378623201 · Rx 33540 |
— | 30 / 1 days | 3 of 3 | 2024-06-05 | 2024-06-06 | Overdue |