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 |
|---|---|---|---|---|---|---|
| CITALOPRAM 40MG TAB 40MG 57664050918 · Rx 36652 |
— | 10 / 10 days | 5 of 5 | 2026-04-07 | 2026-04-17 | Overdue |
| TRAZODONE 100MG TAB 100MG 00591559910 · Rx 36651 |
— | 5 / 5 days | 10 of 10 | 2026-04-07 | 2026-04-12 | Overdue |