Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| PSB SYNTHETIC B1 | PSB STAGE TRANSMISSION | WB-F6-990189 | WB-E2E-F6 | 1 | Primary |
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 |
|---|---|---|---|---|
| ELIGIBLE_PROPOSED SUCCEEDED | AUTOMATIC | system-automation | <nil> · paid by reviewed fake fixture | 2026-09-08 00:39:11 +0000 UTC |
| ELIGIBLE_PROPOSED SUCCEEDED | AUTOMATIC | system-automation | <nil> · paid by reviewed fake fixture | 2026-09-07 23:59:09 +0000 UTC |
| Medication | Sig | Qty / days supply | Refills remaining | Last fill | Next due | Status |
|---|---|---|---|---|---|---|
| ALCOHOL PADS 00000001104 · Rx 37204 |
Use 2 sprays in each nostril every 12 hours as needed | 30 / 30 days | 1 of 1 | 2026-09-11 | 2026-10-11 | Active |
| DEMO PACKAGE SMALL BOTTLE #1 1 00000000016 · Rx 37203 |
Use 2 sprays in each nostril every 12 hours as needed | 30 / 30 days | 1 of 1 | 2026-09-11 | 2026-10-11 | Active |
| DEMO PACKAGE SMALL BOX #5 00000000015 · Rx 37202 |
30 manual daily | 30 / 30 days | 3 of 3 | 2026-09-11 | 2026-10-11 | Active |
| DEMO PACKAGE SMALL BOX #5 00000000015 · Rx 37201 |
30 manual daily | 30 / 30 days | 3 of 3 | 2026-09-11 | 2026-10-11 | Active |
| DEMO PACKAGE SMALL BOX #5 00000000015 · Rx 37200 |
30 manual daily | 30 / 30 days | 3 of 3 | 2026-09-11 | 2026-10-11 | Active |
| DEMO PACKAGE SMALL BOX #5 00000000015 · Rx 37198 |
Use 2 sprays in each nostril every 12 hours as needed | 30 / 30 days | 1 of 1 | 2026-09-11 | 2026-10-11 | Active |
| DEMO PACKAGE SMALL BOX #4 4 00000000014 · Rx 37196 |
Use 2 sprays in each nostril every 12 hours as needed | 30 / 30 days | 1 of 1 | 2026-09-10 | 2026-10-10 | Active |
| DEMO PACKAGE SMALL BOX #3 3 00000000013 · Rx 37192 |
Use 2 sprays in each nostril every 12 hours as needed | 30 / 30 days | 1 of 1 | 2026-09-10 | 2026-10-10 | Active |
| DEMO PACKAGE SMALL BOX #2 00000000012 · Rx 37189 |
Use 2 sprays in each nostril every 12 hours as needed | 30 / 30 days | 1 of 1 | 2026-09-10 | 2026-10-10 | Active |
| DEMO PACKAGE SMALL BOX 00000000011 · Rx 37184 |
Use 2 sprays in each nostril every 12 hours as needed | 30 / 30 days | 1 of 1 | 2026-09-09 | 2026-10-09 | Active |
| COMPOUNDED ORAL LIQ 00000000000 · Rx 37183 |
Use 2 sprays in each nostril every 12 hours as needed | 30 / 30 days | 1 of 1 | 2026-09-09 | 2026-10-09 | Active |
| 12 HR NASAL 0.05% SPR 0.05% 59390003613 · Rx 37182 |
Use 2 sprays in each nostril every 12 hours as needed | 30 / 30 days | 1 of 1 | 2026-09-09 | 2026-10-09 | Active |
| 12 HR NASAL 0.05% SPR 0.05% 59390003613 · Rx 37180 |
Use 2 sprays in each nostril every 12 hours as needed | 30 / 30 days | 1 of 1 | 2026-09-07 | 2026-10-07 | Active |
| 12 HR NASAL 0.05% SPR 0.05% 59390003613 · Rx 37179 |
Use 2 sprays in each nostril every 12 hours as needed | 30 / 30 days | 1 of 1 | 2026-09-07 | 2026-10-07 | Active |
| 12 HR NASAL 0.05% SPR 0.05% 59390003613 · Rx 37177 |
Use 2 sprays in each nostril every 12 hours as needed | 30 / 30 days | 1 of 1 | 2026-09-07 | 2026-10-07 | Active |