Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| PRIVATE | PR | Secondary | |||
| RELAY TEST PLAN COPAY | 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 |
|---|---|---|---|---|---|---|
| FERROUS SULF 325MG TAB 325MG 57664007101 · Rx 36851 |
— | 7 / 7 days | 1 of 1 | 2026-05-26 | 2026-06-02 | Overdue |
| FLONASE ALGY 50MCG SPR 50MCG 00135057604 · Rx 33359 |
— | 28 / 28 days | 0 of 1 | 2024-11-06 | 2024-12-04 | Completed |
| THYROID 130MG TAB 130MG 00677165910 · Rx 33358 |
— | 28 / 28 days | 3 of 3 | 2024-04-23 | 2024-05-21 | Overdue |
| CALAMINE LOT 8-8% 00904253300 · Rx 33360 |
— | 1 / 1 days | 0 of 0 | 2024-04-23 | 2024-04-24 | Completed |