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 |
|---|---|---|---|---|---|---|
| ALPRAZOLAM 0.25MG TAB 0.25MG 67253090011 · Rx 36822 |
— | 28 / 28 days | 5 of 5 | 2026-05-15 | 2026-06-12 | Overdue |
| VIMPAT 100MG TAB 100MG 00131247835 · Rx 36823 |
— | 28 / 28 days | 5 of 5 | 2026-05-14 | 2026-06-11 | Overdue |
| NAPROXEN 500MG TAB 500MG 68462019001 · Rx 36785 |
— | 30 / 30 days | 6 of 6 | 2026-05-11 | 2026-06-10 | Overdue |
| BUSPIRONE 15MG TAB 15MG 00093100305 · Rx 36782 |
— | 30 / 30 days | 1 of 1 | 2026-05-11 | 2026-06-10 | Overdue |
| METFORMIN 1000MG TAB 1000MG 68462016105 · Rx 36784 |
— | 56 / 28 days | 3 of 3 | 2026-05-11 | 2026-06-08 | Overdue |
| TRAZODONE 150MG TAB 150MG 60505265501 · Rx 36783 |
— | 28 / 28 days | 0 of 0 | 2026-04-01 | 2026-04-29 | Completed |
| SERTRALINE 25MG TAB 25MG 16714061105 · Rx 36740 |
— | 28 / 28 days | 1 of 1 | 2026-04-01 | 2026-04-29 | Overdue |