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 |
|---|---|---|---|---|---|---|
| ABILIFY 10MG TAB 10MG 59148000835 · Rx 36230 |
— | 90 / 90 days | 3 of 3 | 2025-11-25 | 2026-02-23 | Overdue |
| IBUPROFEN 100/5ML SUS 100/5ML 45802095243 · Rx 35829 |
— | 30 / 30 days | 5 of 5 | 2025-08-18 | 2025-09-17 | Overdue |
| ZOLOFT 100MG TAB 100MG 00049491073 · Rx 35830 |
— | 28 / 28 days | 5 of 5 | 2025-08-18 | 2025-09-15 | Overdue |
| DOXYCYC MONO 100MG CAP 100MG 68180065208 · Rx 32121 |
— | 6 / 6 days | 1 of 3 | 2023-08-01 | 2023-08-07 | Overdue |
| UCARE INSULIN SYR 0.3/31G 5/16 0.3/31G 08222074393 · Rx 32119 |
— | 6 / 6 days | 1 of 3 | 2023-08-01 | 2023-08-07 | Overdue |
| IBUPROFEN 200MG TAB 200MG 65162056550 · Rx 32122 |
— | 6 / 6 days | 1 of 2 | 2023-05-17 | 2023-05-23 | Overdue |
| DOXAZOSIN 1MG TAB 1MG 60505009300 · Rx 32120 |
— | 12 / 6 days | 1 of 2 | 2023-05-17 | 2023-05-23 | Overdue |
| SPRAVATO 84MG DOS SOL 84MG DOS 50458002803 · Rx 31915 |
— | 3 / 1 days | 2 of 3 | 2023-03-23 | 2023-03-24 | Overdue |
| SPRAVATO 84MG DOS SOL 84MG DOS 50458002803 · Rx 31832 |
— | 3 / 3 days | 0 of 1 | 2023-02-17 | 2023-02-20 | Completed |