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 |
|---|---|---|---|---|---|---|
| ALPRAZOLAM 0.25MG TAB 0.25MG 67253090011 · Rx 36684 |
— | 1 / 1 days | 1 of 1 | 2026-04-15 | 2026-04-16 | Overdue |
| DIAZEPAM 10MG TAB 10MG 00603321521 · Rx 36683 |
— | 1 / 1 days | 0 of 0 | 2026-04-15 | 2026-04-16 | Completed |
| NAPROXEN 220MG TAB 220MG 00904523059 · Rx 35653 |
— | 7 / 7 days | 3 of 3 | 2025-07-16 | 2025-07-23 | Overdue |
| MAPAP 500MG TAB 500MG 00904198380 · Rx 35652 |
— | 7 / 7 days | 3 of 3 | 2025-07-16 | 2025-07-23 | Overdue |