Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| PRIVATE | PR | Secondary | |||
| RELAY TEST PLAN COPAY | 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 |
|---|---|---|---|---|---|---|
| HALDOL 10MG TAB 10MG 00045024660 · Rx 35866 |
— | 7 / 7 days | 2 of 3 | 2025-11-21 | 2025-11-28 | Overdue |
| BENZTROPINE 0.5MG TAB 0.5MG 76385010301 · Rx 35935 |
— | 7 / 7 days | 1 of 1 | 2025-09-12 | 2025-09-19 | Overdue |