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 |
|---|---|---|---|---|---|---|
| CLOZAPINE 100MG TAB 100MG 00172436060 · Rx 384 |
— | 224 / 28 days | 0 of 1 | 2007-03-22 | 2007-04-19 | Completed |
| CLOZAPINE 100MG TAB 100MG 00172436060 · Rx 100 |
— | 240 / 30 days | 0 of 1 | 2006-12-22 | 2007-01-21 | Completed |
| CLOZAPINE 100MG TAB 100MG 00172436060 · Rx 94 |
— | 224 / 28 days | 0 of 1 | 2006-08-28 | 2006-09-25 | Completed |