Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| PSB | PSBF6 | UHC98273465 | G5678901 | 1 | Primary |
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 |
|---|---|---|---|---|---|---|
| PAP-ZYPREXA 10MG TAB 10MG 00002411730 · Rx 37136 |
— | 30 / 30 days | 2 of 2 | 2026-08-14 | 2026-09-13 | Overdue |
| ABACAVIR/LAMIVUDINE 600-300MG 600-300 66993048230 · Rx 37135 |
— | 30 / 30 days | 2 of 2 | 2026-08-14 | 2026-09-13 | Overdue |
| PAP-ZYPREXA 10MG TAB 10MG 00002411730 · Rx 37133 |
— | 30 / 30 days | 2 of 2 | 2026-08-14 | 2026-09-13 | Overdue |
| PAP-ZYPREXA 10MG TAB 10MG 00002411730 · Rx 37132 |
— | 30 / 30 days | 2 of 2 | 2026-08-14 | 2026-09-13 | Overdue |
| GLYB/METFORM 5/500MG TAB 5-500MG 00781517201 · Rx 37130 |
— | 30 / 30 days | 2 of 2 | 2026-08-14 | 2026-09-13 | Overdue |
| METFORMIN 1000MG ER TAB 1000MG 65162017750 · Rx 37129 |
— | 30 / 30 days | 2 of 2 | 2026-08-14 | 2026-09-13 | Overdue |
| PAP-ZYPREXA 10MG TAB 10MG 00002411730 · Rx 37134 |
— | 30 / 20 days | 2 of 2 | 2026-08-14 | 2026-09-03 | Overdue |
| CIALIS 10MG TAB 10MG 00002446330 · Rx 37131 |
— | 30 / 20 days | 2 of 2 | 2026-08-14 | 2026-09-03 | Overdue |
| COZAAR 100MG TAB 100MG 00006096031 · Rx 37125 |
— | 30 / 20 days | 3 of 3 | 2026-08-13 | 2026-09-02 | Overdue |
| COZAAR 100MG TAB 100MG 00006096031 · Rx 37123 |
— | 30 / 20 days | 3 of 3 | 2026-08-13 | 2026-09-02 | Overdue |
| COZAAR 100MG TAB 100MG 00006096031 · Rx 37122 |
— | 30 / 20 days | 3 of 3 | 2026-08-13 | 2026-09-02 | Overdue |
| METFORMIN 1000MG ER TAB 1000MG 65162017750 · Rx 37119 |
— | 30 / 20 days | 3 of 3 | 2026-08-12 | 2026-09-01 | Overdue |
| METFORMIN 1000MG ER TAB 1000MG 65162017750 · Rx 37115 |
— | 30 / 20 days | 3 of 3 | 2026-08-12 | 2026-09-01 | Overdue |
| METFORMIN 1000MG ER TAB 1000MG 65162017750 · Rx 37126 |
— | 0 / 0 days | 0 of 0 | 2026-08-13 | 2026-08-13 | Completed |