RXHRES :: Release 1 :: SCRIPT

The following message specification was auto-generated using the Messaging Workbench tool . This specification was auto-generated from a standard-based message profile. The comments and annotations included in this specification are those provided by the message profile authors as implementation notes and notes included in the associated Messaging Workbench file.

For more information about the NCPDP SCRIPT,

refer to National Council for Prescription Drug Programs : www.ncpdp.org

Overview

 

The NCI Terminology is available at: http://evs.nci.nih.gov/ftp1/NCPDP/  
     

   This specification combines the information available in the SCRIPT Implementation  Guide 10.6

  • 8. Transmission from sender to receiver structure
  • 9. Structure Quick  Reference  
  • 10. Specific segment discussion

This specification is also including an analysis of the changes introduced in version 10.11 of the SCRIPT implementation guide and compares the implementation guide guidance with the XML Schema Descriptions (XSD) provided for XML-encoded SCRIPT messages.

A Medication History request (RXHREQ) can be responded to with a Medication History response (RXHRES), a Status message (STATUS), or an Error message (ERROR). Medication History Response (RXHRES) transaction includes Source and Fill Number information so the receiver's system when appropriate to send, so receivers will be able to de-duplicate records from multiple sources that reflect the same medication dispensing, and better determine patient compliance for the medication. The information also assists the receiver if follow-up contact is required regarding the medication records. If more medication history information is available within the date range provided, or if no date range was provided and more medication history information is available, a Response Type, coded (Response Segment 020-1131) 'AQ' of 'More Medication History Available' is returned. For a Medication History Response (RXHRES), in the RES Segment, Response Type, coded (010-4343), the acceptable values are 'A' (Approved) and 'D' (Denied). If the Medication History Request fails, an ERROR message is returned.

 

Notation

The following codes are used in this specification to refer to message element usage and table column names:

Usage CodesAbbreviations
RMandatory/Required elementReferenceReference for an element
RERequired but may be emptyTypeData Type (alphanumeric, numeric, date/time, composite)
CConditional - based on predicate evaluationLengthMax Length - for fields, components, and sub-components
CEConditional but may be emptyUsageElement Usage
XNot supportedCardinalityMinimum and Maximum number of occurrences

Summary

Specification Name SCRIPT
Organization NCPDP
SCRIPT Version 10.6
Specification Version 1
Application RoleSender
Conformance TypeConstrainable
Encodings XML
  
Event DescriptionSCRIPT Version 10.6 Implementation Guide
Message TypeSCRIPT
Event TypeNRXHRES
Message Profile StructureRES,[PVDP2],[PVDPC],PTTRXHRES,COO,{[(MedicationDispensed)[DRU1],[PVDP2],[PVDPC],[DRU2],{[SIG]},[SRC]]}

Message Structure

SegmentDescriptionUsageCardinality
RESResponse segment used for "NewRxRequestType" XML elementR[1..1]
PVDP2PVD-P2 Segment to specify the "Pharmacy" XML elementRE[0..1]
PVDPCPVD-PC corresponding to the "Prescriber" XML elementRE[0..1]
PTTRXHRESPTT segment for "Patient" XML element in RXHRESR[1..1]
COOCoordination of Benefits segment corresponding to the "BenefitsCoordination" XML elementR[1..1]
MedicationDispensedMedicationDispensedC[0..300]
...
SegmentDescriptionUsageCardinality
DRU1Drug Segment for "MedicationDispensed" XML elementC[0..1]
PVDP2PVD-P2 Segment to specify the "Pharmacy" XML elementC[0..1]
PVDPCPVD-PC corresponding to the "Prescriber" XML elementC[0..1]
DRU2Second set of elements from the Drug Segment as they appear in the "MedicationDispensed" XML elementC[0..1]
SIG"StructuredSIG" XML element corresponds to SIG segmentC[0..*]
SRCSource Segment (Prescriber) represented as "HistorySource" XML elementC[0..1]
  
Message Structure IdRXHRES

Interactions

MedicationDispensed : MedicationDispensed

Loops through up to 300 times. Each loop may have 1 corresponding SRC Segment, 2 corresponding PVD Segments, 1 or more than 1 corresponding Sig Segment

Note that the order of the elements in the XML schema differs from the structure specified in the Implementation Guide. The XML structure requires that the PVD segments for pharmacy and prescriber are interspersed among the  elements of the DRU segment.

Detail

MedicationDispensed

Segment/ElementDescriptionUsageCardinality
DRU1Drug Segment for "MedicationDispensed" XML elementC[0..1]
PVDP2PVD-P2 Segment to specify the "Pharmacy" XML elementC[0..1]
PVDPCPVD-PC corresponding to the "Prescriber" XML elementC[0..1]
DRU2Second set of elements from the Drug Segment as they appear in the "MedicationDispensed" XML elementC[0..1]
SIG"StructuredSIG" XML element corresponds to SIG segmentC[0..*]
SRCSource Segment (Prescriber) represented as "HistorySource" XML elementC[0..1]

RES : Response segment used for "NewRxRequestType" XML element

Designates whether the prescription history was supplied (values accepted or denied supported).

Response segment used for "NewRxRequestType" XML element Detail

ReferenceXML ReferenceIG ReferenceNotesTypeLengthUsageCardinalityValue SetValidation Pattern
RES-010Approved (choice)ResponseType, coded

transaction responses (see 'Structure Quick Reference' section). See chart below. A = Approved D = Denied C = Approved with changes

Predicate:
Request was approved.
RESPONSE75C[ 0 .. 1 ]   
RES-020ApprovalReasonCodeCode List Qualifier

Approval  Reason Code Codes used in response messages by the ultimate receiver.

Repeats up to 10 times.

AN2R[ 1 .. 1 ] External Code ListAA|AB|AC|AD|AE|AF|AG|AH|AJ|AK|
|AL|AM|AN|AO|AP|AQ





 
RES-030ReferenceNumberReference Number

Transaction Key. Used in conjunction with same field described above in the REQ Segment. The Mailbox may return the positional key of the specific piece of mail within their files.

AN1C[ 0 .. 1 ]  [ !-~]*





 
RES-040NoteFree Text

Note

AN70C[ 0 .. 1 ]  [ !-~]*





 
RES-010Denied (Choice)ResponseType, coded

transaction responses (see 'Structure Quick Reference' section). See chart below. A = Approved D = Denied C = Approved with changes

Predicate:
Request was denied.
RESPONSE75C[ 0 .. 1 ]   
RES-020ReasonCodeCode List Qualifier

Approve/Deny Reason Code Codes used in response messages by the ultimate receiver.

Repeats up to 10 times.

AN2R[ 1 .. 1 ] External Code ListAA|AB|AC|AD|AE|AF|AG|AH|AJ|AK|
|AL|AM|AN|AO|AP|AQ





 
RES-030ReferenceNumberReference Number

Transaction Key. Used in conjunction with same field described above in the REQ Segment. The Mailbox may return the positional key of the specific piece of mail within their files.

AN1C[ 0 .. 1 ]  [ !-~]*





 
RES-040NoteFree Text

Note

AN70C[ 0 .. 1 ]  [ !-~]*





 

PVDP2 : PVD-P2 Segment to specify the "Pharmacy" XML element

Provider Segment used for Pharmacy- all its elements are optional.

This segment specialization appears in the XML structure as "Pharmacy"  XML element.

PVD-P2 Segment to specify the "Pharmacy" XML element Detail

ReferenceXML ReferenceIG ReferenceNotesTypeLengthUsageCardinalityValue SetValidation Pattern
PVD-020IdentificationReference number and Reference Qualifier

Optional in this structure but mandatory otherwise.

ID_TYPE863C[ 0 .. 1 ]   
Choice for PVD-020NCPDPIDReference number and Reference Qualifier

Alphanumeric, D3

On the mandatory transactions: One occurrence must contain the value 'D3' (NCPDP Provider ID Number). One occurrence must contain the value 'HPI' (National Provider ID

AN35R[ 1 .. 1 ]  





 
Choice for PVD-020FileIDReference number and Reference Qualifier

Alphanumeric, 94

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020StateLicenseNumberReference number and Reference Qualifier

Alphanumeric, 0B

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020MedicareNumberReference number and Reference Qualifier

Alphanumeric, 1C

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020MedicaidNumberReference number and Reference Qualifier

Alphanumeric,1D

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020DentistLicenseNumberReference number and Reference Qualifier

Alphanumeric, 1E

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020UPINReference number and Reference Qualifier

Alphanumeric, 1G

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020FacilityIDReference number and Reference Qualifier

Alphanumeric, 1J

Choice

Predicate:
Not applicable
AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PPONumberReference number and Reference Qualifier

Alphanumeric, 1M

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PayerIDReference number and Reference Qualifier

Alphanumeric, 2U

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020ProcessorIdentificationNumberReference number and Reference Qualifier

Alphanumeric, ADI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020BINLocationNumberReference number and Reference Qualifier

Alphanumeric, BO

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020CommercialReference number and Reference Qualifier

Alphanumeric, C1

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020MedicalRecordIdentificationNumberEHRReference number and Reference Qualifier

Alphanumeric, EA

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PatientAccountNumberReference number and Reference Qualifier

Alphanumeric, EJ

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020DEANumberReference number and Reference Qualifier

Alphanumeric, DH

Choice

AN35R[ 1 .. 1 ]  





 
Choice for PVD-020HINReference number and Reference Qualifier

Alphanumeric, HI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020IndividualPolicyNumberReference number and Reference Qualifier

Alphanumeric, IP

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020SecondaryCoverageReference number and Reference Qualifier

Alphanumeric, NC

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020NAICCodeReference number and Reference Qualifier

Alphanumeric, NF

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PromotionNumberReference number and Reference Qualifier

Alphanumeric, PD

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020SocialSecurityReference number and Reference Qualifier

Alphanumeric, SY

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020NPIReference number and Reference Qualifier

Alphanumeric, HPI

One occurrence must contain the value 'HPI'  (National Provider ID) for mandatory occurences of this segment.   Choice

Predicate:
Applicable in this case
AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PriorAuthorizationReference number and Reference Qualifier

Alphanumeric, G1

Choice

AN35C[ 0 .. 1 ]  





 
PVD-040SpecialtyAgency Qualifier, coded

The source of the code list for 040- I007-03-7990 Provider Specialty code. Required if Provider Specialty code (040-I007-03-7990) is used. Values: See External Code List

AN10C[ 0 .. 1 ]  [ !-~]*





 
PVD-050PharmacistName

Pharmacist's Name "The name of the prescriber or pharmacist or supervisor. This composite is broken into individual section for each part of the name."

NAME_TYPE129C[ 0 .. 1 ]   
PVD-050-1LastNameLast Name

Since this field is marked CM - this component is required. This assumption should apply to any mandatory composite field.

AN35R[ 1 .. 1 ]  [ !-~]*





 
PVD-050-2FirstNameFirst Name

First name required if the Phamacist's name is required.

AN35R[ 1 .. 1 ]  [ !-~]*





 
PVD-050-3MiddleNameMiddle Name

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-050-3SuffixSuffix

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 
PVD-050-5PrefixPrefix

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 
PVD-070StoreNameParty Name

The clinic or pharmacy name in one field.

In NEWRX this element name is "BusinessName". ERROR: In XML, the is a lack of consistency in referring to the same element in different messages.

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-080AddressAddress

The composite for the prescriber or pharmacist or supervisor address. Further defined fields are used for specific section of the address.

ADDRESS_TYPE1120C[ 0 .. 1 ]   
PVD-080-1AddressLine1Street and Number/P.O. Box

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-080-2AddressLine2Street and Number/P.O. Box

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-080-3CityCity Name

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-080-4StateCountry Sub-entity identification

United States and Canadian Province Postal Service Abbreviations. Values: See External Code List.

AN2C[ 0 .. 1 ]  AL|AK|AZ|AR|AS|CA|CO|CT|DE|DC|
|FM|FL|GA|GU|HI|ID|IL|IN|IA|KS
|KY|LA|ME|MH|MD|MA|MI|MN|MS|MO
|MT|NE|NV|NH|NJ|NM|NY|NC|ND|MP
|OH|OK|OR|PW|PA|PR|RI|SC|SD|TN
|TX|UT|VT|VA|VI|WA|WV|WI|WY|AB
|BC|MB|NB|NF|NS|NT|NU|ON|PE|QC
|SK|YT
PVD-080-5ZipCodePostcode Identification

ZIP code of the pharmacy or prescriber. Use the format 99999 or 999999999. Is not to include hyphen (-).

AN9C[ 0 .. 1 ]  (\d{5})|(\d{9})





 
PVD-080-6PlaceLocationQualifierPlace/Location Qualifier

Alphanumeric, free text. This field is locally defined "Agreement between trading partners if used." Should this be constrained and eliminated?

AN999C[ 0 .. 1 ]  [ !-~]*





 
PVD-090CommunicationNumbersCommunication Numbers

Provider contact number. Prescriber telephone number or other contact number. May occur multiple times when used with qualifier and repetition separator. Used with qualifiers in field 090-01 Code List qualifier.

COMM_TYPE83C[ 0 .. * ]   
PVD-090-1NumberCommunication Number

Telephon number, mandatory, max 80 length

AN80R[ 1 .. 1 ]  ([!-~]|[ ])*[!-~]([!-~]|[ ])*





 
PVD-090-2QualifierCode List Qualifier

Qualifies the Communication Number. X- 12 DE 365. When used, one occurrence is 'TE' (Telephone). Other occurrences are optional and would contain other values. Values: See External Code List

BN Beeper CP Cellular EM Electronic Mail FX Fax HP Home NP Night TE Telephone WP Work

AN2C[ 0 .. 1 ]  BN|CP|FX|HP|NP|TE|WP|EM





 

PVDPC : PVD-PC corresponding to the "Prescriber" XML element

Provider Segment used for Prescriber- all its elements are optional.

NOTE: In the SCRIPT implementation guide this is the first PVD, in the XML XSD this information follows the "Pharmacy" PVD- P2 segment.

PVD-PC corresponding to the "Prescriber" XML element Detail

ReferenceXML ReferenceIG ReferenceNotesTypeLengthUsageCardinalityValue SetValidation Pattern
PVD-020IdentificationReference number and Reference Qualifier

PVD-020 On the mandatory transactions: One occurrence is the prescriber number. One occurrence may be used to identify the clinic. One occurrence may be used to identify a supervisor. At least one occurrence of the PVD- 020-01 and '02 must contain 'HPI' (NPI). Prescriber individual (not organizational) NPI Number is mandatory. This is mandatory for the PVD (PC), not the PVD (SU). For all transactions except RXHRES, if the prescriber has an NPI, one occurrence must contain the value 'HPI' (NPI). For all transactions except RXHRES, if the prescriber has a DEA number, one occurrence must contain the value 'DH' (DEA Number)

ERROR: The XML Schema does not allow repetitions. NOTE: This element combines the reference number and qualifier but it does not exclude the identifiers types that are not applicable to prescribers.

ID_TYPE863C[ 0 .. 1 ]   
Choice for PVD-020NCPDPIDReference number and Reference Qualifier

Alphanumeric, D3

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020FileIDReference number and Reference Qualifier

Alphanumeric, 94

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020StateLicenseNumberReference number and Reference Qualifier

Alphanumeric, 0B

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020MedicareNumberReference number and Reference Qualifier

Alphanumeric, 1C

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020MedicaidNumberReference number and Reference Qualifier

Alphanumeric,1D

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020DentistLicenseNumberReference number and Reference Qualifier

Alphanumeric, 1E

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020UPINReference number and Reference Qualifier

Alphanumeric, 1G

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020FacilityIDReference number and Reference Qualifier

Alphanumeric, 1J

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PPONumberReference number and Reference Qualifier

Alphanumeric, 1M

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PayerIDReference number and Reference Qualifier

Alphanumeric, 2U

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020ProcessorIdentificationNumberReference number and Reference Qualifier

Alphanumeric, ADI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020BINLocationNumberReference number and Reference Qualifier

Alphanumeric, BO

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020CommercialReference number and Reference Qualifier

Alphanumeric, C1

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020MedicalRecordIdentificationNumberEHRReference number and Reference Qualifier

Alphanumeric, EA

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PatientAccountNumberReference number and Reference Qualifier

Alphanumeric, EJ

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020DEANumberReference number and Reference Qualifier

Alphanumeric, DH

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020HINReference number and Reference Qualifier

Alphanumeric, HI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020IndividualPolicyNumberReference number and Reference Qualifier

Alphanumeric, IP

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020SecondaryCoverageReference number and Reference Qualifier

Alphanumeric, NC

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020NAICCodeReference number and Reference Qualifier

Alphanumeric, NF

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PromotionNumberReference number and Reference Qualifier

Alphanumeric, PD

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020SocialSecurityReference number and Reference Qualifier

Alphanumeric, SY

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020NPIReference number and Reference Qualifier

Alphanumeric, HPI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PriorAuthorizationReference number and Reference Qualifier

Alphanumeric, G1

Choice

AN35C[ 0 .. 1 ]  





 
PVD-040SpecialtyAgency Qualifier, coded

Required if 040-I007-01-4709 Agency Qualifier, coded is used. This attribute is encoded using an ASC X12 code. according to the External Code List reference it was modified as follows: "Deleted existing values (may be used in SCRIPT Standard Versions 5.0 - 10.4; added new value for use in SCRIPT Standard Version 10.5 or higher". The specification does not indicate what the values are or whether any specialty code specified by X12 is allowed.

040-I007-02-4707 is no longer supported.

AN10C[ 0 .. 1 ] 4709[ !-~]*





 
PVD-070CliniclNameParty Name

The clinic or pharmacy name in one field.

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-050NameName

Prescriber's Name "The name of the prescriber or pharmacist or supervisor. This composite is broken into individual section for each part of the name."

NAME_TYPE129C[ 0 .. 1 ]   
PVD-050-1002-01LastNameLast Name

This field is marked as "conditional" but it should be mandatory in the context of the parent element (i.e. if the name appears, then the last name is required).

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-050-1002-02FirstNameFist Name

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-050-1002-03MiddleNameMiddle Name

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-050-1002-04SuffixSuffix

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 
PVD-050-1002-05PrefixPrefix

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 
PVD-080AddressPrescriber's Address

The composite for the prescriber or pharmacist or supervisor address. Further defined fields are used for specific section of the address.

ADDRESS_TYPE1120C[ 0 .. 1 ]   
PVD-080-1AddressLine1Street and Number/P.O. Box

Alphanumeric

AN35R[ 1 .. 1 ]  [ !-~]*





 
PVD-080-2AddressLine2Street and Number/P.O. Box

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-080-3CityCity Name

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-080-4StateCountry Sub-entity identification

United States and Canadian Province Postal Service Abbreviations. Values: See External Code List.

AN2C[ 0 .. 1 ]  AL|AK|AZ|AR|AS|CA|CO|CT|DE|DC|
|FM|FL|GA|GU|HI|ID|IL|IN|IA|KS
|KY|LA|ME|MH|MD|MA|MI|MN|MS|MO
|MT|NE|NV|NH|NJ|NM|NY|NC|ND|MP
|OH|OK|OR|PW|PA|PR|RI|SC|SD|TN
|TX|UT|VT|VA|VI|WA|WV|WI|WY|AB
|BC|MB|NB|NF|NS|NT|NU|ON|PE|QC
|SK|YT
PVD-080-5ZipCodePostcode Identification

ZIP code of the pharmacy or prescriber. Use the format 99999 or 999999999. Is not to include hyphen (-).

AN9C[ 0 .. 1 ]  (\d{5})|(\d{9})





 
PVD-080-6PlaceLocationQualifierPlace/Location Qualifier

Alphanumeric, free text. This field is locally defined "Agreement between trading partners if used." Should this be constrained and eliminated?

AN999C[ 0 .. 1 ]  [ !-~]*





 
PVD-090CommunicationNumbersCommunication Numbers

Provider contact number. Prescriber telephone number or other contact number. May occur multiple times when used with qualifier and repetition separator. Used with qualifiers in

COMM_TYPE83R[ 1 .. * ]   
PVD-090-1NumberCommunication Number

Telephone number, mandatory, max 80 length

AN80R[ 1 .. 1 ]  ([!-~]|[ ])*[!-~]([!-~]|[ ])*





 
PVD-090-2QualifierCode List Qualifier

Qualifies the Communication Number. X- 12 DE 365. When used, one occurrence is TE (Telephone). Other occurrences are optional and would contain other values. Values: See External Code List

BN Beeper CP Cellular EM Electronic Mail FX Fax HP Home NP Night TE Telephone WP Work

AN2C[ 0 .. 1 ] X-12 DE 365BN|CP|FX|HP|NP|TE|WP|EM





 
PVD-100PrescriberAgent 

The order of this element is changed for the RXHRES structure. In NEWRX it appears before CommunicationNumbers

NAME_TYPE129C[ 0 .. 1 ]   
PVD-100-1LastNameParty Name

Last name of the Designated Agent. This field is to be used in the 'PC' PVD Segment loop only.

This field should be marked as required in the XSD because it would be required if the name appears at all. Otherwise a name may appear with empty child elements.

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-100-2FirstNameFirst Name

First name of the Designated Agent.

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-100-3MiddleNameMiddle Name

Middle name of the Designated Agent..

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-100-4SuffixSuffix

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 
PVD-100-5PrefixPrefix

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 

PTTRXHRES : PTT segment for "Patient" XML element in RXHRES

PTT for RXHRES, all elements are optional

PTT segment for "Patient" XML element in RXHRES Detail

ReferenceXML ReferenceIG ReferenceNotesTypeLengthUsageCardinalityValue SetValidation Pattern
PTT-010PatientRelationshipIndividual Relationship, coded

Defines the relationship of patient to cardholder.

1 (Cardholder), 2 (Spouse), 3 (Child), 4 (Other).

AN1C[ 0 .. 1 ] External Code List1|2|3|4





 
PTT-050IdentificationReference number and Reference Qualifier

The ordering of this element in the RXHRES - MedicationHistoryReponse XML is changed from NewPrecription/NEWRX.

NOTE: This element combines the reference number and qualifier but it does not exclude the identifiers types that are not applicable to prescribers.

ID_TYPE863C[ 0 .. 2 ]   
Choice for PTT-050NCPDPIDReference number and Reference Qualifier

Alphanumeric, D3

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050FileIDReference number and Reference Qualifier

Alphanumeric, 94

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050StateLicenseNumberReference number and Reference Qualifier

Alphanumeric, 0B

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050MedicareNumberReference number and Reference Qualifier

Alphanumeric, 1C

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050MedicaidNumberReference number and Reference Qualifier

Alphanumeric,1D

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050DentistLicenseNumberReference number and Reference Qualifier

Alphanumeric, 1E

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050UPINReference number and Reference Qualifier

Alphanumeric, 1G

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050FacilityIDReference number and Reference Qualifier

Alphanumeric, 1J

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050PPONumberReference number and Reference Qualifier

Alphanumeric, 1M

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050PayerIDReference number and Reference Qualifier

Alphanumeric, 2U

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050ProcessorIdentificationNumberReference number and Reference Qualifier

Alphanumeric, ADI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050BINLocationNumberReference number and Reference Qualifier

Alphanumeric, BO

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050CommercialReference number and Reference Qualifier

Alphanumeric, C1

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050MedicalRecordIdentificationNumberEHRReference number and Reference Qualifier

Alphanumeric, EA

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050PatientAccountNumberReference number and Reference Qualifier

Alphanumeric number, (Qualifier= 'EJ')

This is a possible choice for patient identifier types. Choice

AN35R[ 1 .. 1 ]  





 
Choice for PTT-050DEANumberReference number and Reference Qualifier

Alphanumeric, DH

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050HINReference number and Reference Qualifier

Alphanumeric, HI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050IndividualPolicyNumberReference number and Reference Qualifier

Alphanumeric, IP

This is a possible choice for patient identifier types. Choice

AN35RE[ 0 .. 1 ]  





 
Choice for PTT-050SecondaryCoverageReference number and Reference Qualifier

Alphanumeric, NC

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050NAICCodeReference number and Reference Qualifier

Alphanumeric, NF

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050PromotionNumberReference number and Reference Qualifier

Alphanumeric, PD

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050SocialSecurityReference number and Reference Qualifier

Alphanumeric, SY

This is a possible choice for patient identifier types. Choice

AN35RE[ 0 .. 1 ]  





 
Choice for PTT-050NPIReference number and Reference Qualifier

Alphanumeric, HPI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PTT-050PriorAuthorizationReference number and Reference Qualifier

Alphanumeric, G1

Choice

AN35C[ 0 .. 1 ]  





 
PT-030Name 

This composite is the name of the patient. Further defined fields separate the name into components.

NAME_TYPE129C[ 0 .. 1 ]   
PT-030-1LastName 

Last name of patient.

AN35R[ 1 .. 1 ]  [ !-~]*





 
PT-030-2FirstName 

First name of the patient.

AN35R[ 1 .. 1 ]  [ !-~]*





 
PT-030-3MiddleName 

Middlename should be specified if available.

AN35RE[ 0 .. 1 ]  [ !-~]*





 
PT-030-4Suffix 

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 
PT-030-5Prefix 

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 
PTT-040GenderGender, coded

Gender of the patient. X-12 DE 1069. Values: M = Male F = Female U = Unknown

AN1C[ 0 .. 1 ]  M|F|U





 
PTT-020DateOfBirth 

This is s choice in XML- either date or date/time may be specified.

DATE_TIME33C[ 0 .. 1 ]   
Choice for PTT-020Date 

Birth Date of patient. Format: CCYYMMDD Note: Whenever possible, Birth Date of patient should be sent.

DT8R[ 1 .. 1 ]  ^\d{4}((0\d)|(1[0-2]))((([0-2]
]\d)|(3[0-1])))?$





 
Choice for PTT-020Date/Time 

Date and Time

DTM24C[ 0 .. 1 ]  ^\d{4}(((0[1-9])|(1[0-2]))(((0
0[1-9])|([1-2]\d)|(3[0-1]))(((
[01]\d|2[0-3])([0-5]\d))(([0-5
]\d)((\.\d{1,4}))?)?)?)?)?([+-
](([0]\d|1[0-3])([0-5]\d)))?$


 
PTT-060Address 

The composite for the patient address. Further defined fields are used for specific section of the address. Note: Whenever possible, the patient address fields should be sent.

If the address of the patient is unable to be obtained, the text 'UNKNOWN' should be put in the Street Address.

ADDRESS_TYPE1120C[ 0 .. 1 ]   
PTT-060-1AddressLine1Street and Number/P.O. Box

Street and Number/P.O. Box Note: Whenever possible, the patient address fields should be sent

If patient is homeless, the text 'HOMELESS' should be put in the Street Address.

AN35C[ 0 .. 1 ]  [ !-~]*





 
PTT-060-1AddressLine2Street and Number/P.O. Box

Street and Number/P.O. Box Note: Whenever possible, the patient address fields should be sent

AN35C[ 0 .. 1 ]  [ !-~]*





 
PTT-060-2CityCity Name

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PTT-060-3StateCountry Sub-entity identification

identification United States and Canadian Province Postal Service Abbreviations. Values: See External Code List.

AN2C[ 0 .. 1 ]  AL|AK|AZ|AR|AS|CA|CO|CT|DE|DC|
|FM|FL|GA|GU|HI|ID|IL|IN|IA|KS
|KY|LA|ME|MH|MD|MA|MI|MN|MS|MO
|MT|NE|NV|NH|NJ|NM|NY|NC|ND|MP
|OH|OK|OR|PW|PA|PR|RI|SC|SD|TN
|TX|UT|VT|VA|VI|WA|WV|WI|WY|AB
|BC|MB|NB|NF|NS|NT|NU|ON|PE|QC
|SK|YT
PTT-060-4ZipCodePostcode Identification

Postal Code ZIP code of the pharmacy or prescriber. Use the format 99999 or 999999999. Is not to include hyphen (-).

AN9C[ 0 .. 1 ]  (\d{5})|(\d{9})





 
PTT-060-5PlaceLocationQualifierPlace/Location Qualifier

Alphanumeric, free text. This field is locally defined "Agreement between trading partners if used." Should this be constrained and eliminated?

AN999C[ 0 .. 1 ]  [ !-~]*





 
PTT-070CommunicationNumbers 

Patient contact number. May occur multiple times when used with qualifier and repetition separator. Used with qualifiers in field 070-02 Code List qualifier.

COMM_TYPE83C[ 0 .. 1 ]   
PTT-070-1Number 

Telephone number, mandatory, max 80 length

AN80R[ 1 .. 1 ]  ([!-~]|[ ])*[!-~]([!-~]|[ ])*





 
PTT-070-1QualifierCode List Qualifier

Qualifies the Communication Number. X- 12 DE 365. When used, one occurrence is 'TE' (Telephone). Other occurrences are optional and would contain other values.

BN Beeper CP Cellular EM Electronic Mail FX Fax HP Home NP Night TE Telephone WP Work

AN2C[ 0 .. 1 ]  BN|CP|FX|HP|NP|TE|WP|EM





 
PTT-080PatientLocation 

Patient location elements order was changed for XML. Facility. --> Room --> Bed became Facility --> Bed --> Room.

LOCATION_TYPE57C[ 0 .. 1 ]   
PTT-080-1FacilityUnitFacility Unit

The unit of the patient.

AN35C[ 0 .. 1 ]  [ !-~]*





 
PTT-080-3BedBed

The bed of the patient.

AN10C[ 0 .. 1 ]  [ !-~]*





 
PTT-080-2RoomRoom

The room of the patient.

AN10C[ 0 .. 1 ]  ^\d{4}((0\d)|(1[0-2]))((([0-2]
]\d)|(3[0-1])))?$





 

COO : Coordination of Benefits segment corresponding to the "BenefitsCoordination" XML element

Benefit information used to determine plan and help identify the patient. Also contains the date range for the needed history records.

Coordination of Benefits segment corresponding to the "BenefitsCoordination" XML element Detail

ReferenceXML ReferenceIG ReferenceNotesTypeLengthUsageCardinalityValue SetValidation Pattern
COO-010PayerIdentificationReference number and Reference Qualifier

Choice of relevant identifiers is not restricted to those relevant to Payer identification.

Within each COO Segment, the Reference Number (010-I001) repeats >1 times. For a given Primary Payer loop of the COO Segment, the Reference Number and Qualifier are used to denote identification of the payer, for example with a BIN Number and a Processor Control Number (if applicable). The Reference Number and Reference Qualifier will loop twice if there is a BIN Number (one loop of (010-I001)) and a Processor Control Number (second loop of (010-I001)) to report. If the payer does not use a Processor Control Number, the Reference Number (010- I001) would only loop once, containing the BIN Number.

ID_TYPE863C[ 0 .. 2 ]   
Choice for COO-010NCPDPIDReference number and Reference Qualifier

Alphanumeric, D3

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010FileIDReference number and Reference Qualifier

Alphanumeric, 94

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010StateLicenseNumberReference number and Reference Qualifier

Alphanumeric, 0B

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010MedicareNumberReference number and Reference Qualifier

Alphanumeric, 1C

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010MedicaidNumberReference number and Reference Qualifier

Alphanumeric,1D

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010DentistLicenseNumberReference number and Reference Qualifier

Alphanumeric, 1E

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010UPINReference number and Reference Qualifier

Alphanumeric, 1G

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010FacilityIDReference number and Reference Qualifier

Alphanumeric, 1J

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010PPONumberReference number and Reference Qualifier

Alphanumeric, 1M

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010PayerIDReference number and Reference Qualifier

Alphanumeric, 2U

Choice

AN35RE[ 0 .. 1 ]  





 
Choice for COO-010ProcessorIdentificationNumberReference number and Reference Qualifier

Alphanumeric, ADI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010BINLocationNumberReference number and Reference Qualifier

Alphanumeric, BO

Choice

AN35RE[ 0 .. 1 ]  





 
Choice for COO-010CommercialReference number and Reference Qualifier

Alphanumeric, C1

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010MedicalRecordIdentificationNumberEHRReference number and Reference Qualifier

Alphanumeric, EA

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010PatientAccountNumberReference number and Reference Qualifier

Alphanumeric, EJ

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010DEANumberReference number and Reference Qualifier

Alphanumeric, DH

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010HINReference number and Reference Qualifier

Alphanumeric, HI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010IndividualPolicyNumberReference number and Reference Qualifier

Alphanumeric, IP

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010SecondaryCoverageReference number and Reference Qualifier

Alphanumeric, NC

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010NAICCodeReference number and Reference Qualifier

Alphanumeric, NF

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010PromotionNumberReference number and Reference Qualifier

Alphanumeric, PD

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010SocialSecurityReference number and Reference Qualifier

Alphanumeric, SY

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010NPIReference number and Reference Qualifier

Alphanumeric, HPI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for COO-010PriorAuthorizationReference number and Reference Qualifier

Alphanumeric, G1

Choice

AN35C[ 0 .. 1 ]  





 
COO-020PayerNameParty Name

Payer name CENSUS - if Private Pay ' This is the responsible Party Name.

AN35C[ 0 .. 1 ]  [ !-~]*





 
COO-040ServiceTypeCodedService Type Coded

Medication list contains all current medication orders as of the current date and time of the response, for the patient indicated. Current status is determined by the point of care responder. 'Current' is medication orders which have not been discontinued. Value 'C' is 'Not used' to request medication history from pharmacy or payer/processor. RXHREQ: When this field contains a value of 'C' in the Medication History request message, COO-090-I006 Date composite is not sent. RXHRES: The response echoes back the 'C' value in this field.

This element appears redundant since it is always hardcoded to "C" in this structure.

AN1C[ 0 .. 1 ]  C





 
COO-040CardHolderIDReference Number

Cardholder ID

"CM" field but it is not a composite. This may be a "required but may be empty in some situations" field.

AN35RE[ 0 .. 1 ]  [ !-~]*





 
COO-050ResponsiblePartyParty Name

In NEWRX this field is used specify the full name of the "Card Holder".

NAME_TYPE129C[ 0 .. 1 ]   
COO-050-1LastNameLast Name

Last name of the cardholder

AN35RE[ 0 .. 1 ]  [ !-~]*





 
COO-050-2FirstNameFirst Name

First name of the cardholder

AN35R[ 1 .. 1 ]  [ !-~]*





 
COO-050-3MiddleNameMiddle Name

Middlename of the cardholder

AN35C[ 0 .. 1 ]  [ !-~]*





 
COO-050-4SuffixSuffix

Suffix of the cardholder

AN10C[ 0 .. 1 ]  [ !-~]*





 
COO-050-5PrefixPrefix

Prefix of the cardholder

AN10C[ 0 .. 1 ]  [ !-~]*





 
COO-06-1154GroupIDReference Number

E

AN35C[ 0 .. 1 ]  [ !-~]*





 
Choice for COO-090EffectiveDate 

Effective date - choice element

DATE_TIME33C[ 0 .. 1 ]   
 Date 

Date

DT8RE[ 0 .. 1 ]  ^\d{4}((0\d)|(1[0-2]))((([0-2]
]\d)|(3[0-1])))?$





 
 Date/Time 

Date and Time

DTM0X [ 0 .. 0 ]  ^\d{4}(((0[1-9])|(1[0-2]))(((0
0[1-9])|([1-2]\d)|(3[0-1]))(((
[01]\d|2[0-3])([0-5]\d))(([0-5
]\d)((\.\d{1,4}))?)?)?)?)?([+-
](([0]\d|1[0-3])([0-5]\d)))?$


 
Choice for COO-090ExpirationDate 

Expiration date - choice element

DATE_TIME33C[ 0 .. 1 ]   
 Date 

Date

DT8RE[ 0 .. 1 ]  ^\d{4}((0\d)|(1[0-2]))((([0-2]
]\d)|(3[0-1])))?$





 
 Date/Time 

Date and Time

DTM0X [ 0 .. 0 ]  ^\d{4}(((0[1-9])|(1[0-2]))(((0
0[1-9])|([1-2]\d)|(3[0-1]))(((
[01]\d|2[0-3])([0-5]\d))(([0-5
]\d)((\.\d{1,4}))?)?)?)?)?([+-
](([0]\d|1[0-3])([0-5]\d)))?$


 
COO-130ConsentCondition/Response, coded

Patient Consent Indicator Values: See External Code List Note: If Patient Consent = N, it is expected the Medication History transactions would not be sent.

Predicate:
This value is set to 'Y' if the medication list is provided.
AN1C[ 0 .. 1 ]  Y|N|P|X|Z





 
COO-140PBMMemberIDPatient Identifier

Payer assigned Unique Member ID.

AN80C[ 0 .. 1 ]  [ !-~]*





 

DRU1 : Drug Segment for "MedicationDispensed" XML element

The fields of this segment are part of the "MedicationDispensed" element. The qualifier 'D' is used to specify 'MedicationDispensed'.

This segment is interspersed in XML with Pharmacy and Prescriber (PVD) segment fields.

Drug Segment for "MedicationDispensed" XML element Detail

ReferenceXML ReferenceIG ReferenceNotesTypeLengthUsageCardinalityValue SetValidation Pattern
DRU-010-2 or DRU-10-12DrugDescriptionItem Description

There is a discrepancy in the field length: the implementation guide specifies only 35 "bytes" while the XSD specifies it can be maximum 105 characters. The implementation guide suggests that it's acceptable to abbreviate this field but since it is the only mandatory identifier for the drug it is necessary that this description be detailed and complete.

From the SCRIPT Implementation Guide the following is stated for the Item Description: 'Is the self-contained full drug name, strength, and form.'

AN105R[ 1 .. 1 ]  [ !-~]*





 
DRU-010-3 to 9DrugCodedItem Number

The "Drug number" refers ot the drug coded

DRUG_CODE5143C[ 0 .. 1 ]   
DRU-010-3ProductCodeDrug number

RxNorm preferred product code.

This element of the dataytype should be mandatory. Otherwise a XML message that contains a "DrugCoded" element that is empty would be acceptable though it does not make sense since "DrugCoded" is already optional.

AN35C[ 0 .. 1 ]  [ !-~]*





 
DRU-010-4ProductCodeQualifierCode List Responsibility Agency

Coded: the code list defining the Item Number. X-12 DE 235.

The allowed qualifiers were expanded for version 10.11 to "ND|MF|RT|UN|UP"

AN2C[ 0 .. 1 ] X-12 DE 235ND|MF|UP





 
DRU-010-6StrengthFree Text

Measurement Value - Drug strength. Changed from field 6314 to 4440 in Version 4.0. Field length expanded to an..70.

AN70C[ 0 .. 1 ]  [ !-~]*





 
DRU-010-8DrugDBCodeReference Number

GPI, GCN Seq #, GFC, DDID, SmartKey, GM, Multum MMDC, Multum Drug ID, etc

AN35C[ 0 .. 1 ]  [ !-~]*





 
DRU-010-9DrugDBCodeQualifierReference Qualifier

Code value to define the reference number.

AN2C[ 0 .. 1 ]  ND|MF|RT|UN|UP





 
DRU-010-13FormSourceCodeSource Code List

Code identifying the source organization. Required if Item Form Code (010-I013- 14-7992) used.

The XSD skips elements DRU-010-10 through DRU-010-12.

AN2C[ 0 .. 1 ] 7992AA





 
DRU-010-14FormCodeItem Form Code

Drug form, in a code. Dosage form code. Pharmaceutical Dosage Form. Qualified by Source Code List (7991). Values: See External Code List

AN15C[ 0 .. 1 ] 7991[ !-~]*





 
DRU-010-15StrengthSourceCodeSource Code List

Code identifying the source organization. Required if Item Strength Code (010- I013-16-7993) used. Values: See External Code List

AN2C[ 0 .. 1 ] 7993AB





 
DRU-010-16StrengthCodeItem Strength Code

Drug strength qualifier. Units of Presentation. Qualified by Source Code List (7991). Values: See External Code List

AN15C[ 0 .. 1 ] 7991[ !-~]*





 
DRU-010-17DEASchedule 

Code, the latest available at: http://evs.nci.nih.gov/ftp1/NCPDP/

This element is used to store the DEA Schedule code: C38046 Unspecified C48672 Schedule I Substance C48675 Schedule II C48676 Schedule III C48677 Schedule IV C48679 Schedule V

Predicate:
Required if the medication is categorized as a controlled substance by the Drug Enforcement Administration (DEA). The DEA Schedule would be populated by the system generating the message, and would utilize the Federal DEA Schedule classification code list, based on federal classification of the medication or the state reclassification of the medication.
AN15C[ 0 .. 1 ]  [ !-~]*





 
DRU-020QuantityQuantity Composite

This composite is for the count of tablets or number of grams.

QUANTITY1030C[ 0 .. 2 ]   
DRU-020-2ValueQuantity

This should be a numeric value but it is specified as a string. This element is required if the quantity is transmitted. "On NEWRX, when the DRU 020-I009- 03-1131 value 'QS' value is used, DRU 020-I009-05-7994 Potency Unit Code must equal 'C38046' (Unspecified). DRU 020-I009-02-6060 Quantity must equal '0'."

This element was corrected for 10.11 and became a numeric, mandatory, maximum 11 characters in length (nM...11). Before that is was changed to (an...35) in version 4.0.

AN35R[ 1 .. 1 ]  [0-9]+(\.[0-9]+)?





 
DRU-020-3CodeListQualifierCode List Qualifier

Alphanumeric, coded using Uses X-12 DE 673 value set. Quantity Sufficient (QS) code usage: in care settings where there are established dispensing protocols between the prescriber and the pharmacy/pharmacist, dispensed quantities for certain medication orders are appropriately determined by the pharmacy'based on the prescriber's dosing directions as well as other factors. For example, in the Long Term Care setting, medication orders are typically open-ended. A medication is delivered to the resident's facility on a scheduled basis until the pharmacy is notified that the order has been discontinued by the prescriber. The delivery schedule is determined by each pharmacy based on a variety of factors'with deliveries occurring every 7 days, every 14 days, monthly, etc. Accordingly, the quantity to be dispensed for a given delivery must be determined by the pharmacy to match their particular delivery schedule. For use on the NEWRX message only, DRU 020-I009-03-1131 Code List Qualifier value of the 'QS' qualifier is limited to settings where dispensing protocols are in force between the physician and pharmacy/pharmacist, where such use is in accordance with federal and state regulations. Example settings include long term care, home health care, and outpatient clinics.

'QS' is not used in retail pharmacy NEWRX messages. If a NEWRX message is received by a retail pharmacy with the QS qualifier for a quantity of 0, then an ERROR response message must be returned. The ERROR message will contain a Status type, coded 010-9015 = '900' (Transaction Rejected). In addition, the Code List Qualifier STS-020-1131 (Reject Code) should indicate the rejection; for example, a Reject Code value of '134' to indicate 'DRU potency unit code is invalid.'

AN2R[ 1 .. 1 ] X-12 DE 67338|40|87|QS|CF





 
DRU-020-4UnitSourceCodeSource Code List

Alphanumeric, fixed in the XML "Code identifying the source organization. Required if Potency Unit Code (020-I009-05-7994) is used."

AN2C[ 0 .. 1 ]  AA|AB|AC





 
DRU-020-4PotencyUnitCodePotency Unit Code

Unit of measure. Potency Unit. Qualified by Source Code List (7991).

Uses NCPDP NCI subsets

Predicate:
020-I009-03-1131 value 'QS' value is used, DRU 020-I009-05-7994 Potency Unit Code must equal 'C38046' (Unspecified). DRU 020-I009-02-6060 Quantity must equal '0'.
AN15C[ 0 .. 1 ] 7991[ !-~]*





 
DRU-040DaysSupplyDate

Note: It is strongly recommended that Days Supply (value 'ZDS' be supported.

Backwards compatibility note: The order was modified in version 10.11.

AN35C[ 0 .. 1 ]  [ !-~]*





 
DRU-030-2 and 3DirectionsDosage

SIG instructions. Dosage free text. Note: If Structured Sig Segment is used, see Note in Structured Sig Segment - Sig Free Text String Indicator (030-S024- 01-7902).

This element in the XML structure combines DRU-030-2 and 3.

AN140C[ 0 .. 1 ]  [ !-~]*





 
DRU-090NoteFree Text

Backwards compatibility: the order of the DRU segment was changed in 10.11 thus the later version is not  backwards compatible with 10.6.

AN210C[ 0 .. 1 ]  [ !-~]*





 
DRU-060-1Refills/QualifierQuantity Qualifier

This field does not appear in 10.11 because the qualifier is assumed to be 'R' in all cases for NEWRX.

R = Number of Refills 'R' implies an Original Dispensing in addition to the Quantity specified in DRU 060-I009-02- 6060. Example: If DRU 060-I009-01- 6063 = 'R' and DRU 060-I009-02-6060 = 3, the prescriber is authorizing fourdispensings. This value will appear in NEWRX messages and will not appear in REFRES messages. See Note 2. A = Additional Refills Authorized 'A' implies no Original Dispensing in addition to the quantity specified in DRU 060-I009-02-6060. Example: If DRU 060-I009-01-6063 = 'A' and DRU 060-I009-02-6060 = 3, the prescriber is authorizing three dispensings. This value will appear only in REFRES

AN3C[ 0 .. 2 ]  R|PRN





 
DRU-060-2Refills/ValueQuantity Value

This element specifies the number of refills allowed.

Renamed "NumberOfRefills" in version 10.11 and the type was change to numeric (n..2) and used without a qualifier - it is assumed to be"R".

AN35C[ 0 .. 2 ]  [ !-~]*





 
DRU-050SubstitutionsProduct/Service Substitution, coded

NCPDP value list. Value 0 = No Product Selection Indicated. This value should be used to designate that substitutions are allowed. When a prescriber wishes to allow substitutes for a NEWRX, this field should be ' to reflect that substitutions can be allowed. Values: See the NCPDP External Code List for definitions of values. 0 = No Product Selection Indicated 1 = Substitution Not Allowed by Prescriber 2 = Substitution Allowed - Patient Requested Product Dispensed 3 = Substitution Allowed - Pharmacist Selected Product Dispensed 4 = Substitution Allowed - Generic Drug Not in Stock 5 = Substitution Allowed - Brand Drug Dispensed as a Generic 7 = Substitution Not Allowed - Brand Drug Mandated by Law 8 = Substitution Allowed - Generic Drug Not Available in Marketplace (6 was intentionally left off)

AN1C[ 0 .. 1 ]  0|1|2|3|4|5|7|8





 
DRU-040-2 (85)WrittenDateDate/Time/Period

For Medication History Response (RXHRES): If the entity has fill history, Last Fill Date must be used. If the entity has prescribing data, date authorized (Date Written) must be used. For all transaction except VERIFY - At least one loop must contain 85 = Date Issued (Written Date) REFREQ ' At least one loop must contain LD ' (Last Fill). Value '06' (Sold Date) is only allowed to be used in Medication History Response, Fill Status Notification, and Refill Request transactions.

Qualifier - 85 is implied.

DATE_TIME33R[ 1 .. 1 ]   
Choice for DRU-040-2 (85)Date 

Date

DT8C[ 0 .. 1 ]  ^\d{4}((0\d)|(1[0-2]))((([0-2]
]\d)|(3[0-1])))?$





 
Choice for DRU-040-2 (85)Date/Time 

Date and Time

DTM24C[ 0 .. 1 ]  ^\d{4}(((0[1-9])|(1[0-2]))(((0
0[1-9])|([1-2]\d)|(3[0-1]))(((
[01]\d|2[0-3])([0-5]\d))(([0-5
]\d)((\.\d{1,4}))?)?)?)?)?([+-
](([0]\d|1[0-3])([0-5]\d)))?$


 
DRU-040 (LD)LastFillDateDate/Time/Period

For Medication History Response (RXHRES): If the entity has fill history, Last Fill Date must be used. If the entity has prescribing data, date authorized (Date Written) must be used. For all transaction except VERIFY - At least one loop must contain 85 = Date Issued (Written Date) REFREQ At least one loop must contain LD (Last Fill). Value '06' (Sold Date) is only allowed to be used in Medication History Response, Fill Status Notification, and Refill Request transactions.

Qualifier - LD is implied.

DATE_TIME33C[ 0 .. 1 ]   
Choice for DRU-040 (LD)Date 

Date

DT8C[ 0 .. 1 ]  ^\d{4}((0\d)|(1[0-2]))((([0-2]
]\d)|(3[0-1])))?$





 
Choice for DRU-040 (LD)Date/Time 

Date and Time

DTM24C[ 0 .. 1 ]  ^\d{4}(((0[1-9])|(1[0-2]))(((0
0[1-9])|([1-2]\d)|(3[0-1]))(((
[01]\d|2[0-3])([0-5]\d))(([0-5
]\d)((\.\d{1,4}))?)?)?)?)?([+-
](([0]\d|1[0-3])([0-5]\d)))?$


 
DRU-040 (36)ExpirationDateDate/Time/Period

Qualifier - 36 is implied

DATE_TIME33C[ 0 .. 1 ]   
Choice for DRU-040 (36)Date 

Date

DT8C[ 0 .. 1 ]  ^\d{4}((0\d)|(1[0-2]))((([0-2]
]\d)|(3[0-1])))?$





 
Choice for DRU-040 (36)Date/Time 

Date and Time

DTM24C[ 0 .. 1 ]  ^\d{4}(((0[1-9])|(1[0-2]))(((0
0[1-9])|([1-2]\d)|(3[0-1]))(((
[01]\d|2[0-3])([0-5]\d))(([0-5
]\d)((\.\d{1,4}))?)?)?)?)?([+-
](([0]\d|1[0-3])([0-5]\d)))?$


 
DRU-040 (07)EffectiveDateDate/Time/Period

Qualifier - 07 is implied

DATE_TIME33C[ 0 .. 1 ]   
Choice for DRU-040 (07)Date 

Date

DT8C[ 0 .. 1 ]  ^\d{4}((0\d)|(1[0-2]))((([0-2]
]\d)|(3[0-1])))?$





 
Choice for DRU-040 (07)Date/Time 

Date and Time

DTM24C[ 0 .. 1 ]  ^\d{4}(((0[1-9])|(1[0-2]))(((0
0[1-9])|([1-2]\d)|(3[0-1]))(((
[01]\d|2[0-3])([0-5]\d))(([0-5
]\d)((\.\d{1,4}))?)?)?)?)?([+-
](([0]\d|1[0-3])([0-5]\d)))?$


 
DRU-040 (PE)PeriodEndDate/Time/Period

Qualifier - PE is implied

DATE_TIME33C[ 0 .. 1 ]   
Choice for DRU-040 (PE)Date 

Date

DT8C[ 0 .. 1 ]  ^\d{4}((0\d)|(1[0-2]))((([0-2]
]\d)|(3[0-1])))?$





 
Choice for DRU-040 (PE)Date/Time 

Date and Time

DTM24C[ 0 .. 1 ]  ^\d{4}(((0[1-9])|(1[0-2]))(((0
0[1-9])|([1-2]\d)|(3[0-1]))(((
[01]\d|2[0-3])([0-5]\d))(([0-5
]\d)((\.\d{1,4}))?)?)?)?)?([+-
](([0]\d|1[0-3])([0-5]\d)))?$


 
DRU-040 (35)DeliveredOnDateDate/Time/Period

Qualifier - 35 is implied

DATE_TIME33C[ 0 .. 1 ]   
Choice for DRU-040 (35)Date 

Date

DT8C[ 0 .. 1 ]  ^\d{4}((0\d)|(1[0-2]))((([0-2]
]\d)|(3[0-1])))?$





 
Choice for DRU-040 (35)Date/Time 

Date and Time

DTM24C[ 0 .. 1 ]  ^\d{4}(((0[1-9])|(1[0-2]))(((0
0[1-9])|([1-2]\d)|(3[0-1]))(((
[01]\d|2[0-3])([0-5]\d))(([0-5
]\d)((\.\d{1,4}))?)?)?)?)?([+-
](([0]\d|1[0-3])([0-5]\d)))?$


 
DRU-040 (BE)DateValidatedDate/Time/Period

Qualifier - BE is implied

DATE_TIME33C[ 0 .. 1 ]   
Choice for DRU-040 (BE)Date 

Date

DT8C[ 0 .. 1 ]  ^\d{4}((0\d)|(1[0-2]))((([0-2]
]\d)|(3[0-1])))?$





 
Choice for DRU-040 (BE)Date/Time 

Date and Time

DTM24C[ 0 .. 1 ]  ^\d{4}(((0[1-9])|(1[0-2]))(((0
0[1-9])|([1-2]\d)|(3[0-1]))(((
[01]\d|2[0-3])([0-5]\d))(([0-5
]\d)((\.\d{1,4}))?)?)?)?)?([+-
](([0]\d|1[0-3])([0-5]\d)))?$


 
DRU-070Diagnosis 

This structure allows senders to specify two sets of primary and secondary diagnoses.

This repeated element allows for repeating groups of Primary and Secondary diagnoses.

DIAGNOSIS999C[ 0 .. 2 ]   
DRU-070-1ClinicalInformationQualifierClinical Information Qualifier

Qualifies the Clinical Information - primary field. Values: See External Code List

AN1R[ 1 .. 1 ]  1|2





 
DRU-070-2PrimaryDiagnosisClinical Information - primary DIAGNOSIS_TYPE21R[ 1 .. 1 ]   
DRU-070-4QualifierCode List Qualifier

E, F, and M are not supported. ABF International Classification of Diseases-10- Clinical Modifications (ICD- 10-CM) DX International Classification of Diseases-9- Clinical Modifications- Diagnosis (ICD-9-CM-Diagnosis E Micromedex/Medical F First DataBank M Medi-Span Product

ABF specifies ICD-10-CM DX specifies ICD-9-CM Diagnosis There is no support for SNOMED-CT.

AN3C[ 0 .. 1 ]  E|F|M|ABF|DX|ICD9|ICD10





 
DRU-070-5Value 

The prescriber supplied or pharmacy inferred code for the diagnosis, coded

AN17R[ 1 .. 1 ]  ([!-~]|[ ])*[!-~]([!-~]|[ ])*





 
DRU-070-4SecondaryDiagnosisClinical Information - secondary DIAGNOSIS_TYPE0X [ 0 .. 0 ]   
DRU-070-4QualifierCode List Qualifier

Alphanumeric ABF International Classification of Diseases-10- Clinical Modifications (ICD- 10-CM) DX International Classification of Diseases-9- Clinical Modifications- Diagnosis (ICD-9-CM-Diagnosis

ABF specifies ICD-10-CM DX specifies ICD-9-CM Diagnosis There is no support for SNOMED-CT and there is no support for Micromedex, Fist DataBank, or Medi-Span, unlike the Primary diagnosis.

AN3O[ 0 .. 1 ] X-12 DE 235E|F|M|ABF|DX|ICD9|ICD10





 
DRU-070-5Value 

The prescriber supplied or pharmacy inferred code for the secondary diagnosis., coded

AN17R[ 1 .. 1 ]  ([!-~]|[ ])*[!-~]([!-~]|[ ])*





 
DRU-080-2PriorAuthorizationReference Number AUTHORIZATION45C[ 0 .. 1 ]   
DRU-080-2QualifierReference Qualifier

Qualifier used to define the Reference Number. X-12 DE 128.   Alphanumeric, validation pattern G1|PD|D3|94|0B|1C|1D|1E|1G|1M|2U|BO|DH| HI|NC|NF|PD|SY|HPI|G1|ZZ

AN1C[ 0 .. 1 ]  G1|PD|D3|94|0B|1C|1D|1E|1G|1M|
|2U|BO|DH|HI|NC|NF|PD|SY|HPI|G
1|ZZ




 
DRU-080-1Value 

Alphanumeric, mandatory. This number is used to store the Prior Authorization or Sample Prescription number or the Prescriber Order Number, if used. Used in conjunction with 02-1153 qualifier field. The Prescriber Order Number resides in this field in a RXHRES transaction only. This field cannot be used for the prescriber order number in other transactions; these occur in the UIH Segment. For RXHRES in each loop of the medication - If the Prescriber Order Number is used, the qualifier of '94' (Pharmacy or Prescriber File ID) is required. The field is used to convey the prescriber order number in a Medication History response.

AN35R[ 1 .. 1 ]  [ !-~]*





 

PVDP2 : PVD-P2 Segment to specify the "Pharmacy" XML element

Provider Segment used for Pharmacy. This segment specialization appears in the XML structure as "Pharmacy"  XML element.

Loop for the pharmacy that dispensed the drug in this DRU Loop. This segment is not used when the sender of the Medication History request is a pharmacy.

PVD-P2 Segment to specify the "Pharmacy" XML element Detail

ReferenceXML ReferenceIG ReferenceNotesTypeLengthUsageCardinalityValue SetValidation Pattern
PVD-020IdentificationReference number and Reference Qualifier

PVD-020 On the mandatory transactions: One occurrence is the prescriber number. One occurrence may be used to identify the clinic. One occurrence may be used to identify a supervisor. At least one occurrence of the PVD- 020-01 and 02 must contain HPI (NPI). Prescriber individual (not organizational) NPI Number is mandatory. This is mandatory for the PVD (PC), not the PVD (SU). For all transactions except RXHRES, if the prescriber has an NPI, one occurrence must contain the value HPI (NPI). For all transactions except RXHRES, if the prescriber has a DEA number, one occurrence must contain the value DH (DEA Number).

One occurrence may be the pharmacist number. NOTE: This element combines the reference number and qualifier but it does not exclude the identifiers types that are not applicable to prescribers.

ID_TYPE863R[ 1 .. 10 ]   
Choice for PVD-020NCPDPIDReference number and Reference Qualifier

Alphanumeric, D3

On the mandatory transactions: One occurrence must contain the value 'D3' (NCPDP Provider ID Number). One occurrence must contain the value 'HPI' (National Provider ID

AN35R[ 1 .. 1 ]  





 
Choice for PVD-020FileIDReference number and Reference Qualifier

Alphanumeric, 94

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020StateLicenseNumberReference number and Reference Qualifier

Alphanumeric, 0B

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020MedicareNumberReference number and Reference Qualifier

Alphanumeric, 1C

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020MedicaidNumberReference number and Reference Qualifier

Alphanumeric,1D

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020DentistLicenseNumberReference number and Reference Qualifier

Alphanumeric, 1E

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020UPINReference number and Reference Qualifier

Alphanumeric, 1G

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020FacilityIDReference number and Reference Qualifier

Alphanumeric, 1J

Choice

Predicate:
Not applicable
AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PPONumberReference number and Reference Qualifier

Alphanumeric, 1M

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PayerIDReference number and Reference Qualifier

Alphanumeric, 2U

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020ProcessorIdentificationNumberReference number and Reference Qualifier

Alphanumeric, ADI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020BINLocationNumberReference number and Reference Qualifier

Alphanumeric, BO

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020CommercialReference number and Reference Qualifier

Alphanumeric, C1

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020MedicalRecordIdentificationNumberEHRReference number and Reference Qualifier

Alphanumeric, EA

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PatientAccountNumberReference number and Reference Qualifier

Alphanumeric, EJ

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020DEANumberReference number and Reference Qualifier

Alphanumeric, DH

Choice

AN35R[ 1 .. 1 ]  





 
Choice for PVD-020HINReference number and Reference Qualifier

Alphanumeric, HI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020IndividualPolicyNumberReference number and Reference Qualifier

Alphanumeric, IP

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020SecondaryCoverageReference number and Reference Qualifier

Alphanumeric, NC

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020NAICCodeReference number and Reference Qualifier

Alphanumeric, NF

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PromotionNumberReference number and Reference Qualifier

Alphanumeric, PD

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020SocialSecurityReference number and Reference Qualifier

Alphanumeric, SY

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020NPIReference number and Reference Qualifier

Alphanumeric, HPI

One occurrence must contain the value 'HPI'  (National Provider ID) for mandatory occurences of this segment.   Choice

Predicate:
Applicable in this case
AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PriorAuthorizationReference number and Reference Qualifier

Alphanumeric, G1

Choice

AN35C[ 0 .. 1 ]  





 
PVD-040SpecialtyAgency Qualifier, coded

The source of the code list for 040- I007-03-7990 Provider Specialty code. Required if Provider Specialty code (040-I007-03-7990) is used. Values: See External Code List

AN10C[ 0 .. 1 ]  [ !-~]*





 
PVD-050PharmacistName

Pharmacist's Name "The name of the prescriber or pharmacist or supervisor. This composite is broken into individual section for each part of the name."

NAME_TYPE129C[ 0 .. 1 ]   
PVD-050-1LastNameLast Name

Since this field is marked CM - this component is required. This assumption should apply to any mandatory composite field.

AN35R[ 1 .. 1 ]  [ !-~]*





 
PVD-050-2FirstNameFirst Name

First name required if the Phamacist's name is required.

AN35R[ 1 .. 1 ]  [ !-~]*





 
PVD-050-3MiddleNameMiddle Name

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-050-3SuffixSuffix

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 
PVD-050-5PrefixPrefix

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 
PVD-070StoreNameParty Name

The clinic or pharmacy name in one field.

This field in the pharmacy segment is also named "BusinessName" in NEWRX.

AN35R[ 1 .. 1 ]  [ !-~]*





 
PVD-080AddressAddress

The composite for the prescriber or pharmacist or supervisor address. Further defined fields are used for specific section of the address.

ADDRESS_TYPE1120C[ 0 .. 1 ]   
PVD-080-1AddressLine1Street and Number/P.O. Box

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-080-2AddressLine2Street and Number/P.O. Box

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-080-3CityCity Name

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-080-4StateCountry Sub-entity identification

United States and Canadian Province Postal Service Abbreviations. Values: See External Code List.

AN2C[ 0 .. 1 ]  AL|AK|AZ|AR|AS|CA|CO|CT|DE|DC|
|FM|FL|GA|GU|HI|ID|IL|IN|IA|KS
|KY|LA|ME|MH|MD|MA|MI|MN|MS|MO
|MT|NE|NV|NH|NJ|NM|NY|NC|ND|MP
|OH|OK|OR|PW|PA|PR|RI|SC|SD|TN
|TX|UT|VT|VA|VI|WA|WV|WI|WY|AB
|BC|MB|NB|NF|NS|NT|NU|ON|PE|QC
|SK|YT
PVD-080-5ZipCodePostcode Identification

ZIP code of the pharmacy or prescriber. Use the format 99999 or 999999999. Is not to include hyphen (-).

AN9C[ 0 .. 1 ]  (\d{5})|(\d{9})





 
PVD-080-6PlaceLocationQualifierPlace/Location Qualifier

Alphanumeric, free text. This field is locally defined "Agreement between trading partners if used." Should this be constrained and eliminated?

AN999C[ 0 .. 1 ]  [ !-~]*





 
PVD-090CommunicationNumbersCommunication Numbers

Provider contact number. Prescriber telephone number or other contact number. May occur multiple times when used with qualifier and repetition separator. Used with qualifiers in field 090-01 Code List qualifier.

COMM_TYPE83R[ 1 .. * ]   
PVD-090-1NumberCommunication Number

Telephon number, mandatory, max 80 length

AN80R[ 1 .. 1 ]  ([!-~]|[ ])*[!-~]([!-~]|[ ])*





 
PVD-090-2QualifierCode List Qualifier

Qualifies the Communication Number. X- 12 DE 365. When used, one occurrence is 'TE' (Telephone). Other occurrences are optional and would contain other values. Values: See External Code List

BN Beeper CP Cellular EM Electronic Mail FX Fax HP Home NP Night TE Telephone WP Work

AN2C[ 0 .. 1 ]  BN|CP|FX|HP|NP|TE|WP|EM





 

PVDPC : PVD-PC corresponding to the "Prescriber" XML element

Loop for the prescriber of the drug in this DRU Loop. This segment specialization appears in the XML structure as "Prescriber" element.

Loop for the prescriber of the drug in this DRU Loop.

PVD-PC corresponding to the "Prescriber" XML element Detail

ReferenceXML ReferenceIG ReferenceNotesTypeLengthUsageCardinalityValue SetValidation Pattern
PVD-020IdentificationReference number and Reference Qualifier

PVD-020 On the mandatory transactions: One occurrence is the prescriber number. One occurrence may be used to identify the clinic. One occurrence may be used to identify a supervisor. At least one occurrence of the PVD- 020-01 and '02 must contain 'HPI' (NPI). Prescriber individual (not organizational) NPI Number is mandatory. This is mandatory for the PVD (PC), not the PVD (SU). For all transactions except RXHRES, if the prescriber has an NPI, one occurrence must contain the value 'HPI' (NPI). For all transactions except RXHRES, if the prescriber has a DEA number, one occurrence must contain the value 'DH' (DEA Number)

ERROR: The XML Schema does not allow repetitions. NOTE: This element combines the reference number and qualifier but it does not exclude the identifiers types that are not applicable to prescribers.

ID_TYPE863R[ 1 .. 10 ]   
Choice for PVD-020NCPDPIDReference number and Reference Qualifier

Alphanumeric, D3

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020FileIDReference number and Reference Qualifier

Alphanumeric, 94

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020StateLicenseNumberReference number and Reference Qualifier

Alphanumeric, 0B

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020MedicareNumberReference number and Reference Qualifier

Alphanumeric, 1C

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020MedicaidNumberReference number and Reference Qualifier

Alphanumeric,1D

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020DentistLicenseNumberReference number and Reference Qualifier

Alphanumeric, 1E

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020UPINReference number and Reference Qualifier

Alphanumeric, 1G

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020FacilityIDReference number and Reference Qualifier

Alphanumeric, 1J

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PPONumberReference number and Reference Qualifier

Alphanumeric, 1M

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PayerIDReference number and Reference Qualifier

Alphanumeric, 2U

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020ProcessorIdentificationNumberReference number and Reference Qualifier

Alphanumeric, ADI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020BINLocationNumberReference number and Reference Qualifier

Alphanumeric, BO

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020CommercialReference number and Reference Qualifier

Alphanumeric, C1

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020MedicalRecordIdentificationNumberEHRReference number and Reference Qualifier

Alphanumeric, EA

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PatientAccountNumberReference number and Reference Qualifier

Alphanumeric, EJ

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020DEANumberReference number and Reference Qualifier

Alphanumeric, DH

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020HINReference number and Reference Qualifier

Alphanumeric, HI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020IndividualPolicyNumberReference number and Reference Qualifier

Alphanumeric, IP

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020SecondaryCoverageReference number and Reference Qualifier

Alphanumeric, NC

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020NAICCodeReference number and Reference Qualifier

Alphanumeric, NF

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PromotionNumberReference number and Reference Qualifier

Alphanumeric, PD

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020SocialSecurityReference number and Reference Qualifier

Alphanumeric, SY

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020NPIReference number and Reference Qualifier

Alphanumeric, HPI

Choice

AN35C[ 0 .. 1 ]  





 
Choice for PVD-020PriorAuthorizationReference number and Reference Qualifier

Alphanumeric, G1

Choice

AN35C[ 0 .. 1 ]  





 
PVD-040SpecialtyAgency Qualifier, coded

Required if 040-I007-01-4709 Agency Qualifier, coded is used. This attribute is encoded using an ASC X12 code. according to the External Code List reference it was modified as follows: "Deleted existing values (may be used in SCRIPT Standard Versions 5.0 - 10.4; added new value for use in SCRIPT Standard Version 10.5 or higher". The specification does not indicate what the values are or whether any specialty code specified by X12 is allowed.

040-I007-02-4707 is no longer supported.

AN10C[ 0 .. 1 ] 4709[ !-~]*





 
PVD-070CliniclNameParty Name

The clinic or pharmacy name in one field.

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-050NameName

Prescriber's Name "The name of the prescriber or pharmacist or supervisor. This composite is broken into individual section for each part of the name."

NAME_TYPE129R[ 1 .. 1 ]   
PVD-050-1002-01LastNameLast Name

This field is marked as "conditional" but it should be mandatory in the context of the parent element (i.e. if the name appears, then the last name is required).

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-050-1002-02FirstNameFist Name

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-050-1002-03MiddleNameMiddle Name

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-050-1002-04SuffixSuffix

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 
PVD-050-1002-05PrefixPrefix

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 
PVD-080AddersPrescriber's Address

The composite for the prescriber or pharmacist or supervisor address. Further defined fields are used for specific section of the address.

ADDRESS_TYPE1120R[ 1 .. 1 ]   
PVD-080-1AddressLine1Street and Number/P.O. Box

Alphanumeric

AN35R[ 1 .. 1 ]  [ !-~]*





 
PVD-080-2AddressLine2Street and Number/P.O. Box

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-080-3CityCity Name

Alphanumeric

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-080-4StateCountry Sub-entity identification

United States and Canadian Province Postal Service Abbreviations. Values: See External Code List.

AN2C[ 0 .. 1 ]  AL|AK|AZ|AR|AS|CA|CO|CT|DE|DC|
|FM|FL|GA|GU|HI|ID|IL|IN|IA|KS
|KY|LA|ME|MH|MD|MA|MI|MN|MS|MO
|MT|NE|NV|NH|NJ|NM|NY|NC|ND|MP
|OH|OK|OR|PW|PA|PR|RI|SC|SD|TN
|TX|UT|VT|VA|VI|WA|WV|WI|WY|AB
|BC|MB|NB|NF|NS|NT|NU|ON|PE|QC
|SK|YT
PVD-080-5ZipCodePostcode Identification

ZIP code of the pharmacy or prescriber. Use the format 99999 or 999999999. Is not to include hyphen (-).

AN9C[ 0 .. 1 ]  (\d{5})|(\d{9})





 
PVD-080-6PlaceLocationQualifierPlace/Location Qualifier

Alphanumeric, free text. This field is locally defined "Agreement between trading partners if used." Should this be constrained and eliminated?

AN999C[ 0 .. 1 ]  [ !-~]*





 
PVD-100PrescriberAgent 

This composite is used to identify the Designated Agent - use for transmitter/submitter name. If a supervising prescriber name or id is required, use another repetition of the PVD Segment placing the id in the reference number field. This composite is to be used in the 'PC' PVD Segment loop only. Note: For NEWRX, REFRES, CANRX or CHGRES ' this field is mandatory if the sender of the message is not the actual prescriber referenced in PVD 020-01

NAME_TYPE129C[ 0 .. 1 ]   
PVD-100-1LastNameParty Name

Last name of the Designated Agent. This field is to be used in the 'PC' PVD Segment loop only.

This field should be marked as required in the XSD because it would be required if the name appears at all. Otherwise a name may appear with empty child elements.

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-100-2FirstNameFirst Name

First name of the Designated Agent.

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-100-3MiddleNameMiddle Name

Middle name of the Designated Agent..

AN35C[ 0 .. 1 ]  [ !-~]*





 
PVD-100-4SuffixSuffix

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 
PVD-100-5PrefixPrefix

Alphanumeric

AN10C[ 0 .. 1 ]  [ !-~]*





 
PVD-090CommunicationNumbersCommunication Numbers

Provider contact number. Prescriber telephone number or other contact number. May occur multiple times when used with qualifier and repetition separator. Used with qualifiers in

COMM_TYPE83R[ 1 .. * ]   
PVD-090-1NumberCommunication Number

Telephone number, mandatory, max 80 length

AN80R[ 1 .. 1 ]  ([!-~]|[ ])*[!-~]([!-~]|[ ])*





 
PVD-090-2QualifierCode List Qualifier

Qualifies the Communication Number. X- 12 DE 365. When used, one occurrence is TE (Telephone). Other occurrences are optional and would contain other values. Values: See External Code List

BN Beeper CP Cellular EM Electronic Mail FX Fax HP Home NP Night TE Telephone WP Work

AN2C[ 0 .. 1 ] X-12 DE 365BN|CP|FX|HP|NP|TE|WP|EM





 

DRU2 : Second set of elements from the Drug Segment as they appear in the "MedicationDispensed" XML element

The fields of this segment are part of the "MedicationPrescribed" element. Item Description Identification "P" for "MedicationPrescribed" and "D" for "MedicationDispensed".

This is the second set of fields interspersed with the PVD elements.

Second set of elements from the Drug Segment as they appear in the "MedicationDispensed" XML element Detail

ReferenceXML ReferenceIG ReferenceNotesTypeLengthUsageCardinalityValue SetValidation Pattern
DRU-100 CPD-030DrugUseEvaluation 

Conditional repeating composite for further explanation, conflict, or clarification of services related to drug use evaluation

DRUG_USE_EVAL112C[ 0 .. 5 ]   
DRU-100-1ServiceReasonCodeDUE Reason For Service Code

Code identifying the type of conflict detected. When this composite is used, DUE Reason For Service Code is mandatory. When the DUE Reason For Service Code is sent from the prescriber to the pharmacist, the DUE Result Of Service Code is mandatory. When the DUE Reason For Service Code is sent from the pharmacist to the prescriber, the DUE Result Of Service code is conditional. This field uses the appropriate values from the Reason For Service Code in NCPDP External Code List.

AN2R[ 1 .. 1 ]  AD|AN|AR|AT|CD|CH|CS|DA|DC|DD|
|DF|DI|DL|DM|DR|DS|ED|ER|EX|HD
|IC|ID|LD|LK|LR|MC|MN|MS|MX|NA
|NC|ND|NF|NN|NP|NR|NS|OH|PA|PC
|PG|PH|PN|PP|PR|PS|RE|RF|SC|SD
|SE|SF|SR|SX|TD|TN|TP|UD

 
DRU-100-2ProfessionalServiceCodeDUE Professional Service Code

Alphanumeric, pattern Code identifying intervention performed when a conflict has been detected. This field uses the appropriate values from the Professional Service Code in the NCPDP External Code List.

AN2C[ 0 .. 1 ]  00|AS|CC|DE|DP|FE|GP|MA|MB|MP|
|M0|MR|PA|PE|PH|PM|P0|PT|R0|RT
|SC|SW|TC|TH|ZZ




 
DRU-100-3ServiceResultCodeDUE Result Of Service Code

Alphanumeric, pattern Action taken in response to a conflict. This field uses the appropriate values from the Result of Service Code in the NCPDP External Code List.

AN2C[ 0 .. 1 ]  00|1A|1B|1C|1D|1E|1F|1G|1H|1J|
|1K|2A|2B|3A|3B|3C|3D|3E|3F|3G
|3H|3J|3K|3M|3N|4A




 
DRU-100-4 and DRU-100-5CoAgentDUE Co-Agent ID

Identifies the co-existing agent contributing to the DUR event (drug or disease) conflicting with the prescribed drug. When DUE Co-Agent ID is used, the DUE Co-Agent ID Qualifier must be present.

COAGENT0X [ 0 .. 0 ]   
DRU-100-5CoAgentIdentifierDUE Co-Agent ID Qualifier

Alphanumeric

AN19O[ 0 .. 1 ]  [ !-~]*





 
DRU-100-5CoAgentQualifierDUE Co-Agent ID Qualifier

Alphanumeric, see regex Code qualifying the value in DUE Co- Agent ID. When DUE Co-Agent ID Qualifier is sent, the DUE Co-Agent ID must be present. This field uses the appropriate values from the DUR Co-Agent Qualifier in the NCPDP External Code List.

AN2O[ 0 .. 1 ]  1|02|03|04|05|07|08|09|11|12|1
13|14|15|16|17|18|19|20|21|22|
23|24|25|26|27|28|29|30|31|32|
33|34|35|36|37|99



 
DRU-100-6ClinicalSignificanceCodeDUE Clinical Significance Code

Alphanumeric, pattern Code identifying the significance or severity level of a clinical event as contained in the originating database.

AN1C[ 0 .. 1 ]  1|2|3|9





 
DRU-100-07AcknowledgementReasonDUE Acknowledgement Reason

Additional textual information regarding intervention and/or acknowledgment associated with a DUE conflict. Mandatory if DUE Professional Service Code (100-S018-02-7881) = 'ZZ' (Other) to provide further explanation

AN100C[ 0 .. 1 ]  [ !-~]*





 
DRU-110DrugCoverageStatusDrug Coverage Status Code

Code identifying the coverage status of the prescribed drug.

Predicate:
This field should only be used for medication prescribed.
AN2C[ 0 .. 5 ]  PR|AP|PA|NF|NR|DC|UN|ST|SI





 
DRU-120PriorAuthorizationStatusPrior Authorization Status

The status of the prescription's prior authorization as known by the sender.

AN1C[ 0 .. 1 ]  A|D|R|N|F





 

SIG : "StructuredSIG" XML element corresponds to SIG segment

The fields of this segment are part of the "MedicationPrescribed" element.

Backwards compatibility note: the order of the SIG elements was changed in 10.11.

"StructuredSIG" XML element corresponds to SIG segment Detail

ReferenceXML ReferenceIG ReferenceNotesTypeLengthUsageCardinalityValue SetValidation Pattern
SIG-010RepeatingSIGREPEATING Sig

The Repeating Sig Composite is used to indicate if there is more than one Sig, such as for a tapered dose or sliding scale.

SIG_SEQUENCE7R[ 1 .. 1 ]   
SIG-010-1SigSequencePositionNumber 

A value of 0 means that the Sig has no repeating elements. Values equal to or greater than 1 are used when the Sig has repeating elements to indicate the position within the string.

N2R[ 1 .. 1 ]  [0-9]+(\.[0-9]+)?





 
SIG-010-2MultipleModifier 

Alphanumeric, pattern AND|OR|THEN Used to express when there is more than one Sig as to whether all the Sigs must apply (AND) or if any of the Sigs can apply (OR) or if the Sigs are sequential (THEN), in the sequence defined by Sig SEQUENCE POSITION.

AN4C[ 0 .. 1 ]  AND|OR|THEN





 
SIG-020CodeSystemCODE SYSTEM

The Code System Composite of the Sig identifies which code system and version are used.

CODE_SYSTEM29R[ 1 .. 1 ]   
SIG-020-1SNOMEDVersion 

The version of The Systematized Nomenclature of Human and Veterinary Medicine (SNOMED) being used.

AN14C[ 0 .. 1 ]  [ !-~]*





 
SIG-020-2FMTVersion 

The version of Federal Medication Terminologies (FMT) being used.

AN14C[ 0 .. 1 ]  [ !-~]*





 
SIG-030FreeTextSig FREE TEXT STRING COMPOSITE

Used to reflect the text string express of the Sig. It should always be used, and in addition is the only composite to place a free text Sig from a generating system that CANNOT generate a structured Sig.

FREE_TEXT142R[ 1 .. 1 ]   
SIG-030-1SigFreeTextStringIndicatorSig Free Text String Indicator

Indicates the system capability of representing the instructions. Note: Value 1. Capture what the MD ordered. The Structured SIG Segment free text is used - free text is what the physician selected. DRU Dosage (030-I014-02 or 030-I014-03) Sig instructions must contain the same text. The Structured SIG Segment contains the codified SIG fields from the prescriber's order. Value 2. Reconstructed from structured Sig. The Structured SIG Segment free text used and it is a direct translation of codified SIG values and must not be structured English language or pharmacist/patient friendly. DRU Dosage (030-I014-02 or 030-I014-03) Sig instructions free text contains what the physician selected. Value 3. Pure free text. Value 3 is not used in the SCRIPT Standard. f the structured Sig cannot be generated, the segment is not used. The DRU Dosage (030-I014-02 or 030-I014-03) Sig instructions free text is used. DRU Dosage (030-I014-02 or 030-I014-03) Sig instructions free text contains what the physician selected.

AN1R[ 1 .. 1 ]  1|2|3





 
SIG-030-2SigFreeTextSig Free Text

Sig Free Text

AN140R[ 1 .. 1 ]  [ !-~]*





 
SIG-040DoseDOSE

The dose composite can define a fixed dose or can repeat to define a variable dose, dose range, or dose options.

DOSE230R[ 1 .. 1 ]   
SIG-040-1DoseCompositeIndicatorDose Composite Indicator

Alphanumeric, pattern 1|2|3|4 Indicates the action to be taken on the Dose Composite fields.

AN1C[ 0 .. 1 ]  1|2|3|4





 
SIG-040-2DoseDeliveryMethodTextDose Delivery Method Text

The textual representation of the Dose Delivery Method. This is the method in which the dose is delivered (describes how the dose is administered/consumed)

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-040-3DoseDeliveryMethodCodeQualifierDose Delivery Method Code Qualifier

Alphanumeric, pattern 1|2 Qualifier to identify the code system being used

AN1C[ 0 .. 1 ]  1|2





 
SIG-040-4DoseDeliveryMethodCodeDose Delivery Method Code

The code representing the Dose Delivery Method Text.

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-040-5DoseDeliveryMethodModifierTextDose Delivery Method Modifier Text

Modifies the method in which the dose is delivered (clarifies Dose Delivery Method Text).

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-040-6DoseDeliveryMethodModifierCodeQualifierDose Delivery Method Modifier Code Qualifier

Qualifier to identify the code system being used. Values: See External Code List

AN1C[ 0 .. 1 ]  1|2





 
SIG-040-7DoseDeliveryMethodModifierCodeDose Delivery Method Modifier Code

The code representing the Dose Delivery Method Modifier Text.

AN15C[ 0 .. 1 ]  1|2





 
SIG-040-8DoseQuantityDose Quantity

The numeric expression of the dose.

N18C[ 0 .. 1 ]  [0-9]+(\.[0-9]+)?





 
SIG-040-9DoseFormTextDose Form Text

The textual representation of the Dose Form

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-040-10DoseFormQualifierDose Form Code Qualifier

Qualifier to identify the code system being used. Values: See External Code List

AN0X [ 0 .. 0 ]  1|2





 
SIG-040-11DoseFormCodeDose Form Code

The code representing the Dose Form

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-040-12DoseRangeModifierDose Range Modifier

Alphanumeric, pattern TO|OR Used to signify that the Sig contains more than one dose in a range or option. Values: See External Code List

AN3C[ 0 .. 1 ]  TO|OR





 
SIG-050DoseCalculationDOSE CALCULATION COMPOSITE

Used to calculate a dose where a body metric such as metric weight or surface area is used to calculate a dose for a patient.

DOSE_CALC198C[ 0 .. 1 ]   
SIG-050-1DosingBasisNumericValueDosing Basis Numeric Value

Expresses the numeric value of the dosing basis.

N18C[ 0 .. 1 ]  [0-9]+(\.[0-9]+)?





 
SIG-050-2DosisBasisUnitofMeasureTextDosing Basis Unit of Measure Text

The textual representation of the dosing basis unit of measure.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-050-3DosingBasisUnitofMeasureCodeQualifierDosing Basis Unit of Measure Code Qualifier

Alphanumeric, pattern 1|2 Qualifier to identify the code system being used.

AN1C[ 0 .. 1 ]  1|2





 
SIG-050-4DosingBasisUnitofMeasureCodeDosing Basis Unit of Measure Code

The code representing the dosing basis unit of measure

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-050-5BodyMetricQualifierBody Metric Qualifier

Alphanumeric, pattern 1|2 Qualifier to identify the body metric being used (either weight or surface area). Values: See External Code List

AN0X [ 0 .. 0 ]  1|2





 
SIG-050-6BodyMetricValueBody Metric Value

Numeric Expresses the value of the body metric.

N18C[ 0 .. 1 ]  [0-9]+(\.[0-9]+)?





 
SIG-050-7CalculateDoseNumericCalculated Dose Numeric

Numeric Expresses the numeric value of the calculated dose

N18C[ 0 .. 1 ]  [0-9]+(\.[0-9]+)?





 
SIG-050-8CalculateDoseUnitofMeasureTextCalculated Dose Unit of Measure Text

The textual representation of the unit of measure of the calculated dose.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-050-9CalcuateDoseUnitofMeasureCodeQualifierCalculated Dose Unit of Measure Code Qualifier

Alphanumeric, pattern 1|2 Qualifier to identify the code system being used. Values: See External Code List

AN1C[ 0 .. 1 ]  1|2





 
SIG-050-10CalculateDoseUnitofMeasureCodeCalculated Dose Unit of Measure Code

Code representing the calculated dose unit of measure.

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-050-11DosingBasisRangeModifierDosing Basis Range Modifier

Alphanumeric, pattern TO|OR Used to signify that the Sig contains more than one dose which represent a dose range (TO) or contains a dose option (OR). Values: See External Code List

AN2C[ 0 .. 1 ]  TO|PR





 
SIG-060VehicleVEHICLE COMPOSITE

Defines a vehicle specified for the delivery of the product.

VEHICLE160C[ 0 .. 1 ]   
SIG-060-1VehicleNameVehicle Name AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-050-2VehicleNameCodeQualifierVehicle Name Code Qualifier

Alphanumeric, pattern 1|2 Vehicle Name Code Qualifier

AN1C[ 0 .. 1 ]  1|2





 
SIG-060-3VehicleNameCodeVehicle Name Code

The code representing the Vehicle Name.

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-060-4VehicleQuantityVehicle Quantity

A volume, expressed in a value.

N18C[ 0 .. 1 ]  [0-9]+(\.[0-9]+)?





 
SIG-060-5VehicleUnitOfMeasureTextVehicle Unit Of Measure Text

The textual representation of Vehicle Unit of Measure.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-060-6VehicleUnitOfMeasureCodeQualifierVehicle Unit Of Measure Code Qualifier

Alphanumeric, pattern 1|2 Qualifier to identify the code system being used. Values: See External Code List

AN1C[ 0 .. 1 ]  1|2





 
SIG-060-7VehicleUnitOfMeasureCodeVehicle Unit Of Measure Code

The code representing the Vehicle Unit of Measure

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-050-8MultipleVehicleModifierMultiple Vehicle Modifier

Alphanumeric, pattern AND|OR Denotes if for an instance of more than one vehicle if all vehicles are used together (AND), or if each of the listed vehicles is an option (OR). Values: See External Code List

AN3C[ 0 .. 1 ]  AND|OR





 
SIG-070RouteofAdministrationROUTE OF ADMINISTRATION COMPOSITE

Defines the route of administration.

ROUTE72C[ 0 .. 1 ]   
SIG-070-1 DRU-180-1RouteofAdministrationTextRoute of Administration Text

Alphanumeric, free text, The textual representation of the Route of Administration

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-070-2 DRU-180RouteofAdministrationCodeQualifierRoute of Administration Code Qualifier

Qualifier to identify the code system being used. Route of Administration Code Qualifier

AN1C[ 0 .. 1 ]  1|2





 
SIG-070-3 DRU-180-3RouteofAdministratoinCodeRoute of Administration Code

The code representing the Route of Administration

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-070-4 DRU-180-4MultipleRouteofAdministrationModifierMultiple Route of Administration Modifier

Alphanumeric, AND/OR Used to express when there is more than one route as to whether the routes are all required to be used (AND) or if any of the routes can be used (OR). Values: See External Code List

AN3C[ 0 .. 1 ]  AND|OR





 
SIG-080SiteofAdministrationSITE OF ADMINISTRATION COMPOSITEPredicate:
Defines the site of administration.
SITE72C[ 0 .. 1 ]   
SIG-080-1SiteofAdministrationTextSite of Administration Text

The textual representation of Site Code. It is the site of administration.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-080-2SiteofAdministrationCodeQualifierSite of Administration Code Qualifier

Qualifier to identify the code system being used.

AN1C[ 0 .. 1 ]  1|2





 
SIG-080-3SiteofAdministrationCodeSite of Administration Code

The code representing the Site of Administration

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-080-4MultipleAdministrationTimingModifierMultiple Site of Administration Timing Modifier

Alphanumeric, AND/OR/NOT Used to express when there is more than one site as to whether the sites are all required (AND) for use or excluded from use (NOT) or if any of the sites can be used (OR).

AN3C[ 0 .. 1 ]  AND|OR|NOT





 
SIG-090TimingSig TIMING COMPOSITE

This composite is used to provide instruction about the timing of the Sig - when/how often/frequently/at what rate - the medication is be taken. Defines a specific administration day, date or time

This composite in XML combines timing, frequency, and interval.

TIMING399C[ 0 .. 1 ]   
SIG-090-1AdministrationTimingTextAdministration Timing Text

The textual representation of Administration Timing.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-090-2AdministrationTimingCodeQualifierAdministration Timing Code Qualifier

Qualifier to identify the code system being used.

AN1C[ 0 .. 1 ]  1|2





 
SIG-090-3AdministrationTimingCodeAdministration Timing Code

The code representing the Administration Timing Text.

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-090-4MultipleAdministrationTimingModifierMultiple Administration Timing Modifier

Alphanumeric, pattern AND|OR e ADMINISTRATION TIME as to whether the times are all required to be used (AND) or if any of the times can be used (OR). Values: See External Code List

AN3C[ 0 .. 1 ]  AND|OR





 
SIG-090-5RateofAdministrationRate of Administration

The amount of time for a {single} dose to be administered

AN11C[ 0 .. 1 ]  [ !-~]*





 
SIG-090-6RateUnitofMeasureTextRate Unit of Measure Text

The textual representation of Rate Unit of Measure for the period of time (seconds, minutes, hours, days) in which the dose is to be administered.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-090-7RateUnitofMeasureCodeQualifierRate Unit of Measure Code Qualifier

Alphanumeric, pattern 1|2 Qualifier to identify the code system being used.

AN1C[ 0 .. 1 ]  1|2





 
SIG-090-8RateUnitofMeasureCodeRate Unit of Measure Code

The code representing the Rate Unit Of Measure Text.

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-090-9TimePeriodBasisTextTime Period Basis Text

Expresses the time unit of measure for the calculated dose.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-090-10TimePeriodBasisCodeQualifierTime Period Basis Code Qualifier

Alphanumeric, pattern 1|2 Qualifier to identify the code system being used.

AN1C[ 0 .. 1 ] External Code List1|2





 
SIG-090-11TimePeriodBasisCodeTime Period Basis Code

The code representing the time period basis.

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-090-12FrequenceNumericValueFrequency Numeric Value

Defines a frequency of administration. Frequency is events per unit of time. The numeric interval for the event. Used to define a FREQUENCY of administration.

AN11C[ 0 .. 1 ]  [ !-~]*





 
SIG-090-13FrequencyUnitsTextFrequency Units Text

The textual representation of Frequency Units Code.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-090-14FrequencyUnitsCodeQualifierFrequency Units Code Qualifier

Alphanumeric, pattern 1|2 Qualifier to identify the code system being used.

AN1C[ 0 .. 1 ]  1|2





 
SIG-090-15FrequencyUnitsCodeFrequency Units Code

The code represented by Frequency Units Text.

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-090-16VariableFrequencyModifierVariable Frequency Modifier

Alphanumeric, pattern AND|OR|TO Used to express when there is more than one FREQUENCY as to whether the frequencies are all required to be used (AND) or if any of the frequencies can be used (OR/TO).

AN3C[ 0 .. 1 ]  AND|OR|TO





 
SIG-090-17IntervalNumericValueInterval Numeric Value

Numeric Defines an interval of administration. Interval is the time between events.

N18C[ 0 .. 1 ]  [0-9]+(\.[0-9]+)?





 
SIG-090-18IntervalUnitsTextInterval Units Text

The textual representation of Interval Units Code.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-090-19IntervalUnitsCodeQualifierInterval Units Code Qualifier

Qualifier to identify the code system being used.

AN1C[ 0 .. 1 ]  1|2





 
SIG-090-20IntervalUnitsCodeInterval Units Code

The code representing the Interval Units Text.

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-090-21VariableIntervalModifierVariable Interval Modifier

Alphanumeric, pattern AND|OR|TO Used to express when there is more than one INTERVAL as to whether the intervals are all required to be used (AND) or if any of the intervals can be used (OR/TO). Values: See External Code List

AN3C[ 0 .. 1 ]  AND|OR|TO





 
SIG-100DurationDURATION COMPOSITE

Defines a duration of use/therapy.

DURATION80C[ 0 .. 1 ]   
SIG-100-1DurationNumericValueDuration Numeric Value

Numeric The numeric duration units.

N11R[ 1 .. 1 ]  [0-9]+(\.[0-9]+)?





 
SIG-100-2DurationTextDuration Text

Alphanumeric The textual representation of Duration Units Code.

AN50R[ 1 .. 1 ]  [ !-~]*





 
SIG-100-3DurationTextCodeQualifierDuration Text Code Qualifier

Qualifier to identify the code system being used.

AN1R[ 1 .. 1 ]  1|2





 
SIG-100-4DurationTextCodeDuration Text Code

The code representing the Duration Units Text.

AN15R[ 1 .. 1 ]  [ !-~]*





 
SIG-110MaximumDoseRestrictionMAXIMUM DOSE RESTRICTION COMPOSITE

The dose restriction composite of the Sig which defines a maximum or dose limit, as specified by the prescriber.

MAX_DOSE179R[ 1 .. 1 ]   
 MaximumDoseRestrictionNumericValueMaximum Dose Restriction Numeric Value

Numeric Defines a MAXIMUM DOSE, so that the Sig can represent the concept, 'Not to exceed _____.' Expression of a DOSE MAXIMUM involves placing the core dose value in this field and the units and variables in the fields that follow.

N18R[ 1 .. 1 ]  [0-9]+(\.[0-9]+)?





 
SIG-110-2MaximumDoseRestrictionUnitsTextMaximum Dose Restriction Units Text

The textual representation of the Dose Maximum Units.

AN50R[ 1 .. 1 ]  [ !-~]*





 
SIG-110-3MaximumDoseRestrictionCodeQualifierMaximum Dose Restriction Code Qualifier

Qualifier 1, 2 Qualifier to identify the code system being used. Values: See External Code List

AN1R[ 1 .. 1 ]  1|2





 
SIG-110-4MaximumDoseRestrictionUnitsCodeMaximum Dose Restriction Units Code

The code representing the Dose Maximum Units Text.

AN15R[ 1 .. 1 ]  [ !-~]*





 
SIG-110-5MaximumDoseRestrictionVariableNumericValueMaximum Dose Restriction Variable Numeric Value

Numeric The numeric representation of the maximum dose calculations.

N18C[ 0 .. 1 ]  [0-9]+(\.[0-9]+)?





 
SIG-110-6MaximumDoseRestrictionVariableUnitsTextMaximum Dose Restriction Variable Units Text

The textual representation of the Dose Maximum Variable Units.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-110-7MaximumDoseRestrictionVariableUnitsCodeQualifierMaximum Dose Restriction Variable Units Code Qualifier

Qualifier 1, 2 Qualifier to identify the code system being used. Required when Maximum Dose Restriction Variable Units Code (110- S033-08-7974) is used. Values: See External Code List

AN1C[ 0 .. 1 ]  1|2





 
SIG-110-8MaximumDoseRestrictionVariableUnitsCodeMaximum Dose Restriction Variable Units Code

The code represented by the Dose Maximum Variable Units Text. Required when Maximum Dose Restriction Variable Units Code Qualifier (110-S033-07-7973) is used.

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-110-9MaximumDoseRestrictionVariableDurationModifierMaximum Dose Restriction Variable Duration Modifier

AND, OR boolean operator Used to express when there is more than one DURATION as to whether the durations are all required to be used (AND) or if any of the durations can be used (OR). Values: See External Code List

AN3C[ 0 .. 1 ]  AND|OR





 
SIG-120IndicationINDICATION COMPOSITE

Defines the indication for use of the medication as meant to be conveyed to the patient.

INDICATION295R[ 1 .. 1 ]   
SIG-120-1IndicationPrecursorTextIndication Precursor Text

The textual representation of the indication precursor.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-120-3IndicationPrecursoCodeQualifierIndication Precursor Code Qualifier

Qualifier 1, 2 Qualifier to identify the code system being used. Values: See External Code List

AN1C[ 0 .. 1 ] External Code List1|2





 
SIG-120-3IndicationPrecursorCodeIndication Precursor Code

The code representing the indication precursor.

AN15R[ 1 .. 1 ]  [ !-~]*





 
SIG-120-4IndicationTextIndication Text

The textual representation of the Indication.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-120-5IndicationTextCodeQualifierIndication Text Code Qualifier

Qualifier 1,2 Qualifier to identify the code system being used. Values: See External Code List

AN1C[ 0 .. 1 ] External Code List1|2





 
SIG-120-6IndicationTextCodeIndication Text Code

The code representing the Indication Text.

AN15C[ 0 .. 1 ]  [ !-~]*





 
SIG-120-7IndicationValueTextIndication Value Text

The textual representation of when the indication value is applicable.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-120-8IndicatoinValueUnitIndication Value Unit

The numeric expression of a value when it applies to an Indication.

AN18C[ 0 .. 1 ]  [ !-~]*





 
SIG-120-9IndicationValueUnitofMeasureTextIndication Value Unit of Measure Text

The textual representation of the unit of measure of the indication value.

AN50C[ 0 .. 1 ]  [ !-~]*





 
SIG-120-10IndicationValueUnitsofMeasureCodeQualifierIndication Value Unit of Measure Code Qualifier

Qualifier 1, 2 Qualifier to identify the code system being used. Values: See External Code List

AN16C[ 0 .. 1 ] External Code List1|2





 
SIG-120-11IndicationValueUnitofMeasureCodeIndication Value Unit of Measure Code

The code representing the unit of measure.

AN15R[ 1 .. 1 ]  [ !-~]*





 
SIG-120-12IndicationVariableModifierIndication Variable Modifier

Logical boolean used to express when there is more than one INDICATION as to whether all the indications must apply (AND) or if any of the indications can apply (OR). Values: See External Code List Used to express a hard stop, such

"TO" is also supported in addition to boolean operators.

AN3C[ 0 .. 1 ] External Code ListAND|OR|TO





 
SIG-130StopStop Indicator

Defines if a stop is present.

Part of the STOP COMPOSITE, it corresponds to SIG-130-1.

AN1C[ 0 .. 1 ]  [ !-~]*





 

SRC : Source Segment (Prescriber) represented as "HistorySource" XML element

Source Segment (Prescriber) represented as "HistorySource" XML element Detail

ReferenceXML ReferenceIG ReferenceNotesTypeLengthUsageCardinalityValue SetValidation Pattern
SRC-010SourceSource composite is represented as a "Source" XML element.

Composite field.

SOURCE38X [ 0 .. 0 ]   
SRC-010-01SourceQualifier 

Qualifies the Source Description. Values: See External Code List

AN2R[ 1 .. 1 ]  PC|P2|PY





 
SRC-010-02SourceDescription 

Name of medication history source.

AN35O[ 0 .. 1 ]  [ !-~]*





 
SRC-010-03, SRC-010-04IDOptionalTypeComposite IDOPTIONALTYPE0X [ 0 .. 0 ]   
 IDValueReference Number

Alphanumeric identifier The identification for the prescriber, pharmacy, payer, et cetera, which is the medication source, which is qualified by the Reference Qualifier below. Required if Reference Qualifier (010- S021-04-1153) is sent.

AN35O[ 0 .. 1 ]  [ !-~]*





 
 IDQualifierReference Qualifier

Qualifier Defines the Reference number, field 1154. X-12 DE 128. Values: See External Code List

AN2O[ 0 .. 1 ]  0B|1C|1D|1E|1G|1M|1J|2U|94|ADI
I|BO|C1|D3|DH|EA|EJ|G1|HI|HPI|
IP|NC|NF|PD|SY|ZZ




 
SRC-020SourceReferenceReference Number

Prescription Number associated to medication history record. If Source Qualifier (010-S021-01-7895) value is 'P2' (Pharmacy), if sent, this field must contain the pharmacy's prescription number. If Source Qualifier (010-S021-01-7895) value is 'PC' (Prescriber), this field is not sent. The Prescriber Order Number is found in DRU-080-I001-01-1154 Reference Number. If Source Qualifier (010-S021-01-7895) value is 'PY' (Payer), if sent, this field must contain the pharmacy's prescription number from the payer system from claims processing.

AN35C[ 0 .. 1 ]  [ !-~]*





 
SRC-030FillNumberFill Number

Defines the dispensing episode as an initial fill or an authorized refill. If Source Qualifier (010-S021-01-7895) value is 'P2' (Pharmacy), if sent, this field must contain the fill number from the pharmacy. If Source Qualifier (010-S021-01-7895) value is 'PC' (Prescriber), this field is not sent. If Source Qualifier (010-S021-01-7895) value is 'PY_ (Payer), if sent, this field must contain the pharmacy's fill number from the payer system from claims processing. Values: 00 = initial fill 01 = first refill 02 = second refill, etc Allowed values 00 through 99

N2C[ 0 .. 1 ]  





 
Created January 10, 2017, Updated March 01, 2017