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 |
|---|---|---|---|---|---|---|
| MONTELUKAST 10MG TAB 10MG 00054025922 · Rx 35214 |
— | 30 / 30 days | 4 of 4 | 2025-05-08 | 2025-06-07 | Overdue |
| BUPROPION SR 150MG TAB 150MG SR 00185041501 · Rx 35213 |
— | 30 / 30 days | 4 of 4 | 2025-05-08 | 2025-06-07 | Overdue |
| IBUPROFEN 100/5ML SUS 100/5ML 00472200294 · Rx 35212 |
— | 30 / 30 days | 3 of 3 | 2025-05-08 | 2025-06-07 | Overdue |
| TRAZODONE 150MG TAB 150MG 50111044102 · Rx 33087 |
— | 60 / 30 days | 3 of 3 | 2024-02-19 | 2024-03-20 | Overdue |
| BUPROPION 100MG ER TAB 100MG ER 67767017160 · Rx 33086 |
— | 60 / 30 days | 3 of 3 | 2024-02-19 | 2024-03-20 | Overdue |
| FLUVASTATIN XL 80MG TAB 12341234123 · Rx 28042 |
— | 30 / 30 days | 10 of 10 | 2016-08-31 | 2016-09-30 | Overdue |
| GOOD & PLENTY WHITE 12345678901 · Rx 27446 |
— | 56 / 28 days | 0 of 0 | 2016-02-16 | 2016-03-15 | Completed |
| GOOD & PLENTY PINK 98765432101 · Rx 27445 |
— | 28 / 28 days | 0 of 0 | 2016-02-16 | 2016-03-15 | Completed |
| HOT TAMLES RED HOT 43289472344 · Rx 27444 |
— | 84 / 28 days | 0 of 0 | 2016-02-16 | 2016-03-15 | Completed |
| CLONIDINE 0.1MG TAB 0.1MG 53489021501 · Rx 21415 |
— | 60 / 30 days | 10 of 12 | 2011-09-22 | 2011-10-22 | Overdue |
| PAP-ABILIFY 10MG TAB 10MG 59148000899 · Rx 21417 |
— | 30 / 30 days | 0 of 0 | 2011-08-09 | 2011-09-08 | Completed |
| FLUVASTATIN XL 80MG TAB 12341234123 · Rx 21416 |
— | 30 / 30 days | 10 of 10 | 2011-08-09 | 2011-09-08 | Overdue |
| RED CANDY 92520001500 · Rx 21419 |
— | 28 / 14 days | 2 of 2 | 2011-08-09 | 2011-08-23 | Overdue |