Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| EXPRESS SCRIPTS INSURANCE | 00000001234 | 0000001234 | S | Secondary | |
| 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 |
|---|---|---|---|---|---|---|
| PAXIL CR 12.5MG TABLET 12.5MG 00029320613 · Rx 220 |
— | 0 / 30 days | 1 of 1 | 2006-10-30 | 2006-11-29 | Overdue |