Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| BC/BS OF FLORIDA-PRIME | Secondary | ||||
| 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 |
|---|---|---|---|---|---|---|
| 1CC SYRINGE LUER-LOK MIS -LOK 1ML 08290309628 · Rx 35253 |
— | 100 / 25 days | 0 of 0 | 2025-05-20 | 2025-06-14 | Completed |
| STERILE WATER FOR INJ WATER 00409488710 · Rx 35254 |
— | 10 / 10 days | 0 of 0 | 2025-05-20 | 2025-05-30 | Completed |
| IBUPROFEN 400MG TAB 400MG 67877031905 · Rx 35252 |
— | 5 / 5 days | 3 of 3 | 2025-05-20 | 2025-05-25 | Overdue |
| AMOXICILLIN 500MG CAPS 500MG 00781261301 · Rx 35251 |
— | 5 / 5 days | 0 of 0 | 2025-05-20 | 2025-05-25 | Completed |
| MAPAP 500MG TAB 500MG 00904198380 · Rx 35250 |
— | 5 / 5 days | 3 of 3 | 2025-05-20 | 2025-05-25 | Overdue |
| NAPROXEN 220MG TAB 220MG 00904523059 · Rx 35249 |
— | 5 / 5 days | 3 of 3 | 2025-05-20 | 2025-05-25 | Overdue |