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 |
|---|---|---|---|---|---|---|
| TOPIRAMATE 25MG TAB 25MG 68382013814 · Rx 25776 |
— | 112 / 28 days | 5 of 5 | 2014-02-06 | 2014-03-06 | Overdue |
| CLONAZEPAM 1MG TAB 1MG 00228300411 · Rx 25775 |
— | 56 / 28 days | 5 of 5 | 2014-02-06 | 2014-03-06 | Overdue |
| BENZTROPINE 1MG TAB 1MG 00832108100 · Rx 25774 |
— | 84 / 28 days | 5 of 5 | 2014-02-06 | 2014-03-06 | Overdue |
| QUETIAPINE 100MG TAB 100MG 00054022125 · Rx 25773 |
— | 84 / 28 days | 5 of 5 | 2014-02-06 | 2014-03-06 | Overdue |