Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| PRIVATE | PR | Secondary | |||
| RELAY TEST PLAN | 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 |
|---|---|---|---|---|---|---|
| SERTRALINE 25MG TAB 25MG 68180035109 · Rx 36113 |
— | 1 / 1 days | 3 of 3 | 2025-11-13 | 2025-11-14 | Overdue |
| PRAVACHOL 10MG TAB 10MG 00003515405 · Rx 33436 |
— | 28 / 28 days | 0 of 2 | 2025-08-01 | 2025-08-29 | Completed |
| THYROID 130MG TAB 130MG 00677165910 · Rx 33435 |
— | 28 / 28 days | 0 of 1 | 2024-10-10 | 2024-11-07 | Completed |
| FLONASE ALGY 50MCG SPR 50MCG 00135057603 · Rx 33437 |
— | 28 / 28 days | 0 of 1 | 2024-09-12 | 2024-10-10 | Completed |