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 |
|---|---|---|---|---|---|---|
| IBUPROFEN 100/5ML SUS 100/5ML 45802095226 · Rx 34748 |
— | 1 / 1 days | 2 of 2 | 2025-02-06 | 2025-02-07 | Overdue |
| PAROXETINE 20MG TAB 20MG 60505008302 · Rx 28790 |
— | 30 / 30 days | 0 of 0 | 2017-04-13 | 2017-05-13 | Completed |
| SAM-SEROQUEL XR 400MG TAB 400MG 00310028460 · Rx 24802 |
— | 60 / 60 days | 0 of 0 | 2012-12-20 | 2013-02-18 | Completed |
| DIVALPROEX ER 500MG TAB 500MG ER 10370051110 · Rx 24803 |
— | 120 / 30 days | 0 of 0 | 2012-12-20 | 2013-01-19 | Completed |
| NAPROXEN 500MG TAB 500MG 00143134801 · Rx 24801 |
— | 60 / 30 days | 0 of 0 | 2012-12-20 | 2013-01-19 | Completed |
| LISINOP-HCTZ 10-12.5 TAB 10-12.5 00172503360 · Rx 24800 |
— | 30 / 30 days | 0 of 0 | 2012-12-20 | 2013-01-19 | Completed |
| ATENOLOL 100MG TAB 100MG 68382002401 · Rx 24799 |
— | 60 / 30 days | 0 of 0 | 2012-12-20 | 2013-01-19 | Completed |