Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| RELAY TEST PLAN | 123456 | 1 | Primary | ||
| PRIVATE | PR | Secondary | |||
| RELAY TEST PLAN COPAY | 654 | 1 | 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 |
|---|---|---|---|---|---|---|
| ALPRAZOLAM 0.25MG TAB 0.25MG 67253090010 · Rx 36721 |
— | 7 / 7 days | 5 of 5 | 2026-04-21 | 2026-04-28 | Overdue |
| HALDOL 0.5MG TAB 0.5MG 00045024060 · Rx 36471 |
— | 10 / 5 days | 1 of 1 | 2026-02-16 | 2026-02-21 | Overdue |