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 |
|---|---|---|---|---|---|---|
| UCARE INSULIN SYR 0.3/29G 1/2" 0.3/29G 08222092397 · Rx 37105 |
— | 100 / 100 days | 0 of 0 | 2026-08-04 | 2026-11-12 | Active |
| MAPAP 500MG TAB 500MG 00904198380 · Rx 37104 |
— | 30 / 30 days | 0 of 0 | 2026-08-04 | 2026-09-03 | Completed |
| SUBOXONE 8-2MG MIS 8-2MG 12496120803 · Rx 37096 |
— | 10 / 10 days | 0 of 0 | 2026-08-03 | 2026-08-13 | Completed |
| NAPROXEN 500MG TAB 500MG 68462019001 · Rx 37095 |
— | 10 / 5 days | 99 of 99 | 2026-08-03 | 2026-08-08 | Overdue |
| DIAZEPAM 10MG GEL 10MG 00093613832 · Rx 37097 |
— | 1 / 1 days | 0 of 0 | 2026-08-04 | 2026-08-05 | Completed |
| NORCO 10-325MG TAB 10-325MG 52544053901 · Rx 37094 |
— | 10 / 1 days | 0 of 0 | 2026-08-03 | 2026-08-04 | Completed |
| ALPRAZOLAM 0.25MG TAB 0.25MG 67253090011 · Rx 37093 |
— | 1 / 1 days | 2 of 2 | 2026-08-03 | 2026-08-04 | Overdue |