Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| ARGUS-TOGETHER RX | Secondary | ||||
| PRIVATE | PR | Secondary | |||
| RELAY TEST PLAN COPAY | 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 |
|---|---|---|---|---|---|---|
| CALCIUM 500MG TAB 500MG 43292055565 · Rx 36691 |
— | 30 / 60 days | 1 of 1 | 2026-04-15 | 2026-06-14 | Overdue |
| ATENOLOL 50MG TAB 50MG 68382002301 · Rx 36693 |
— | 15 / 30 days | 1 of 1 | 2026-04-15 | 2026-05-15 | Overdue |
| BUPROPION HCL 150MG XL TAB 150MG XL 00591333119 · Rx 36692 |
— | 15 / 30 days | 10 of 10 | 2026-04-15 | 2026-05-15 | Overdue |
| AGGRENOX 25-200MG CAP 25-200MG 00597000160 · Rx 36690 |
— | 60 / 30 days | 1 of 1 | 2026-04-15 | 2026-05-15 | Overdue |
| SILDENAFIL 20MG TAB 20MG 68084086921 · Rx 36689 |
— | 20 / 20 days | 0 of 0 | 2026-04-15 | 2026-05-05 | Completed |
| LISINOPRIL 10MG TAB 10MG 00143126701 · Rx 36259 |
— | 5 / 5 days | 1 of 1 | 2025-12-02 | 2025-12-07 | Overdue |
| UCARE INSULIN SYR 0.3/29G 1/2" 0.3/29G 08222092397 · Rx 35731 |
— | 50 / 100 days | 1 of 1 | 2025-07-30 | 2025-11-07 | Overdue |
| VIMPAT 50MG TAB 50MG 00131247735 · Rx 35428 |
— | 30 / 30 days | 1 of 1 | 2025-06-13 | 2025-07-13 | Overdue |
| ALPRAZOLAM 2MG ER TAB 2MG ER 00228308706 · Rx 35427 |
— | 30 / 30 days | 2 of 2 | 2025-06-13 | 2025-07-13 | Overdue |
| VYVANSE 30MG CAP 30MG 59417010310 · Rx 35425 |
— | 30 / 30 days | 0 of 0 | 2025-06-13 | 2025-07-13 | Completed |
| APAP/CODEINE 300-30MG TAB 300-30MG 00093015001 · Rx 35422 |
— | 15 / 15 days | 0 of 0 | 2025-06-13 | 2025-06-28 | Completed |
| PSB SYNTHETIC PRODUCT 00093015001 · Rx 35422 |
— | 15 / 15 days | 0 of 0 | 2025-06-13 | 2025-06-28 | Completed |
| ALPRAZOLAM 0.25MG TAB 0.25MG 00228202710 · Rx 35421 |
— | 1 / 7 days | 3 of 3 | 2025-06-13 | 2025-06-20 | Overdue |
| APAP/CODEINE 300-30MG TAB 300-30MG 00093015001 · Rx 35426 |
— | 10 / 5 days | 0 of 0 | 2025-06-13 | 2025-06-18 | Completed |
| PSB SYNTHETIC PRODUCT 00093015001 · Rx 35426 |
— | 10 / 5 days | 0 of 0 | 2025-06-13 | 2025-06-18 | Completed |
| CALAMINE LOT 8-8% 00904253300 · Rx 35298 |
— | 110 / 15 days | 5 of 5 | 2025-06-02 | 2025-06-17 | Overdue |
| VYVANSE 20MG CAP 20MG 59417010210 · Rx 35420 |
— | 1 / 1 days | 1 of 1 | 2025-06-13 | 2025-06-14 | Overdue |