Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| PSB SYNTHETIC CARE | PSB CARE DEMO | WB-F6-990190 | 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 |
|---|---|---|---|---|
| No E1 eligibility evidence recorded. | ||||
| Medication | Sig | Qty / days supply | Refills remaining | Last fill | Next due | Status |
|---|---|---|---|---|---|---|
| DEMO PACKAGE SMALL BOX #2 00000000012 · Rx 37186 |
Use 2 sprays in each nostril every 12 hours as needed | 30 / 30 days | 1 of 1 | 2026-09-09 | 2026-10-09 | Active |
| DEMO PACKAGE SMALL BOX #3 3 00000000013 · Rx 37199 |
Apply one applicatorful vaginally at bedtime for 3 days | 1 / 3 days | 0 of 0 | 2026-09-11 | 2026-09-14 | Completed |
| DEMO PACKAGE SMALL BOX 00000000011 · Rx 37193 |
Apply one applicatorful vaginally at bedtime for 3 days | 1 / 3 days | 0 of 0 | 2026-09-10 | 2026-09-13 | Completed |
| COMPOUNDED ORAL LIQ 00000000000 · Rx 37190 |
Apply one applicatorful vaginally at bedtime for 3 days | 1 / 3 days | 0 of 0 | 2026-09-10 | 2026-09-13 | Completed |