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
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
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.
The following codes are used in this specification to refer to message element usage and table column names:
Usage Codes | Abbreviations | ||
---|---|---|---|
R | Mandatory/Required element | Reference | Reference for an element |
RE | Required but may be empty | Type | Data Type (alphanumeric, numeric, date/time, composite) |
C | Conditional - based on predicate evaluation | Length | Max Length - for fields, components, and sub-components |
CE | Conditional but may be empty | Usage | Element Usage |
X | Not supported | Cardinality | Minimum and Maximum number of occurrences |
Specification Name | SCRIPT | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Organization | NCPDP | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
SCRIPT Version | 10.6 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Specification Version | 1 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Application Role | Sender | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Conformance Type | Constrainable | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Encodings | XML | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Event Description | SCRIPT Version 10.6 Implementation Guide | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Message Type | SCRIPT | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Event Type | NRXHRES | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Message Profile Structure | RES,[PVDP2],[PVDPC],PTTRXHRES,COO,{[(MedicationDispensed)[DRU1],[PVDP2],[PVDPC],[DRU2],{[SIG]},[SRC]]}
Message Structure
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Message Structure Id | RXHRES |
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.
MedicationDispensed
Segment/Element | Description | Usage | Cardinality |
---|---|---|---|
DRU1 | Drug Segment for "MedicationDispensed" XML element | C | [0..1] |
PVDP2 | PVD-P2 Segment to specify the "Pharmacy" XML element | C | [0..1] |
PVDPC | PVD-PC corresponding to the "Prescriber" XML element | C | [0..1] |
DRU2 | Second set of elements from the Drug Segment as they appear in the "MedicationDispensed" XML element | C | [0..1] |
SIG | "StructuredSIG" XML element corresponds to SIG segment | C | [0..*] |
SRC | Source Segment (Prescriber) represented as "HistorySource" XML element | C | [0..1] |
Designates whether the prescription history was supplied (values accepted or denied supported).
Reference | XML Reference | IG Reference | Notes | Type | Length | Usage | Cardinality | Value Set | Validation Pattern |
---|---|---|---|---|---|---|---|---|---|
RES-010 | Approved (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. |
RESPONSE | 75 | C | [ 0 .. 1 ] | ||
RES-020 | ApprovalReasonCode | Code List Qualifier |
Approval Reason Code Codes used in response messages by the ultimate receiver.
|
AN | 2 | R | [ 1 .. 1 ] | External Code List | AA|AB|AC|AD|AE|AF|AG|AH|AJ|AK| |
RES-030 | ReferenceNumber | Reference 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. |
AN | 1 | C | [ 0 .. 1 ] | [ !-~]* |
|
RES-040 | Note | Free Text |
Note |
AN | 70 | C | [ 0 .. 1 ] | [ !-~]* |
|
RES-010 | Denied (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. |
RESPONSE | 75 | C | [ 0 .. 1 ] | ||
RES-020 | ReasonCode | Code List Qualifier |
Approve/Deny Reason Code Codes used in response messages by the ultimate receiver.
|
AN | 2 | R | [ 1 .. 1 ] | External Code List | AA|AB|AC|AD|AE|AF|AG|AH|AJ|AK| |
RES-030 | ReferenceNumber | Reference 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. |
AN | 1 | C | [ 0 .. 1 ] | [ !-~]* |
|
RES-040 | Note | Free Text |
Note |
AN | 70 | C | [ 0 .. 1 ] | [ !-~]* |
Provider Segment used for Pharmacy- all its elements are optional.
This segment specialization appears in the XML structure as "Pharmacy" XML element.
Reference | XML Reference | IG Reference | Notes | Type | Length | Usage | Cardinality | Value Set | Validation Pattern |
---|---|---|---|---|---|---|---|---|---|
PVD-020 | Identification | Reference number and Reference Qualifier |
Optional in this structure but mandatory otherwise. |
ID_TYPE | 863 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | NCPDPID | Reference number and Reference Qualifier |
Alphanumeric, D3
|
AN | 35 | R | [ 1 .. 1 ] | ||
Choice for PVD-020 | FileID | Reference number and Reference Qualifier |
Alphanumeric, 94
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | StateLicenseNumber | Reference number and Reference Qualifier |
Alphanumeric, 0B
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | MedicareNumber | Reference number and Reference Qualifier |
Alphanumeric, 1C
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | MedicaidNumber | Reference number and Reference Qualifier |
Alphanumeric,1D
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | DentistLicenseNumber | Reference number and Reference Qualifier |
Alphanumeric, 1E
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | UPIN | Reference number and Reference Qualifier |
Alphanumeric, 1G
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | FacilityID | Reference number and Reference Qualifier |
Alphanumeric, 1J
Not applicable |
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PPONumber | Reference number and Reference Qualifier |
Alphanumeric, 1M
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PayerID | Reference number and Reference Qualifier |
Alphanumeric, 2U
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | ProcessorIdentificationNumber | Reference number and Reference Qualifier |
Alphanumeric, ADI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | BINLocationNumber | Reference number and Reference Qualifier |
Alphanumeric, BO
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | Commercial | Reference number and Reference Qualifier |
Alphanumeric, C1
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | MedicalRecordIdentificationNumberEHR | Reference number and Reference Qualifier |
Alphanumeric, EA
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PatientAccountNumber | Reference number and Reference Qualifier |
Alphanumeric, EJ
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | DEANumber | Reference number and Reference Qualifier |
Alphanumeric, DH
|
AN | 35 | R | [ 1 .. 1 ] | ||
Choice for PVD-020 | HIN | Reference number and Reference Qualifier |
Alphanumeric, HI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | IndividualPolicyNumber | Reference number and Reference Qualifier |
Alphanumeric, IP
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | SecondaryCoverage | Reference number and Reference Qualifier |
Alphanumeric, NC
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | NAICCode | Reference number and Reference Qualifier |
Alphanumeric, NF
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PromotionNumber | Reference number and Reference Qualifier |
Alphanumeric, PD
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | SocialSecurity | Reference number and Reference Qualifier |
Alphanumeric, SY
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | NPI | Reference number and Reference Qualifier |
Alphanumeric, HPI
Applicable in this case |
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PriorAuthorization | Reference number and Reference Qualifier |
Alphanumeric, G1
|
AN | 35 | C | [ 0 .. 1 ] | ||
PVD-040 | Specialty | Agency 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 |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050 | Pharmacist | Name |
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_TYPE | 129 | C | [ 0 .. 1 ] | ||
PVD-050-1 | LastName | Last Name |
Since this field is marked CM - this component is required. This assumption should apply to any mandatory composite field. |
AN | 35 | R | [ 1 .. 1 ] | [ !-~]* |
|
PVD-050-2 | FirstName | First Name |
First name required if the Phamacist's name is required. |
AN | 35 | R | [ 1 .. 1 ] | [ !-~]* |
|
PVD-050-3 | MiddleName | Middle Name |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050-3 | Suffix | Suffix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050-5 | Prefix | Prefix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-070 | StoreName | Party Name |
The clinic or pharmacy name in one field.
|
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-080 | Address | Address |
The composite for the prescriber or pharmacist or supervisor address. Further defined fields are used for specific section of the address. |
ADDRESS_TYPE | 1120 | C | [ 0 .. 1 ] | ||
PVD-080-1 | AddressLine1 | Street and Number/P.O. Box |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-080-2 | AddressLine2 | Street and Number/P.O. Box |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-080-3 | City | City Name |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-080-4 | State | Country Sub-entity identification |
United States and Canadian Province Postal Service Abbreviations. Values: See External Code List. |
AN | 2 | C | [ 0 .. 1 ] | AL|AK|AZ|AR|AS|CA|CO|CT|DE|DC| |
|
PVD-080-5 | ZipCode | Postcode Identification |
ZIP code of the pharmacy or prescriber. Use the format 99999 or 999999999. Is not to include hyphen (-). |
AN | 9 | C | [ 0 .. 1 ] | (\d{5})|(\d{9}) |
|
PVD-080-6 | PlaceLocationQualifier | Place/Location Qualifier |
Alphanumeric, free text. This field is locally defined "Agreement between trading partners if used." Should this be constrained and eliminated? |
AN | 999 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-090 | CommunicationNumbers | Communication 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_TYPE | 83 | C | [ 0 .. * ] | ||
PVD-090-1 | Number | Communication Number |
Telephon number, mandatory, max 80 length |
AN | 80 | R | [ 1 .. 1 ] | ([!-~]|[ ])*[!-~]([!-~]|[ ])* |
|
PVD-090-2 | Qualifier | Code 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
|
AN | 2 | C | [ 0 .. 1 ] | BN|CP|FX|HP|NP|TE|WP|EM |
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.
Reference | XML Reference | IG Reference | Notes | Type | Length | Usage | Cardinality | Value Set | Validation Pattern |
---|---|---|---|---|---|---|---|---|---|
PVD-020 | Identification | Reference 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)
|
ID_TYPE | 863 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | NCPDPID | Reference number and Reference Qualifier |
Alphanumeric, D3
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | FileID | Reference number and Reference Qualifier |
Alphanumeric, 94
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | StateLicenseNumber | Reference number and Reference Qualifier |
Alphanumeric, 0B
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | MedicareNumber | Reference number and Reference Qualifier |
Alphanumeric, 1C
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | MedicaidNumber | Reference number and Reference Qualifier |
Alphanumeric,1D
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | DentistLicenseNumber | Reference number and Reference Qualifier |
Alphanumeric, 1E
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | UPIN | Reference number and Reference Qualifier |
Alphanumeric, 1G
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | FacilityID | Reference number and Reference Qualifier |
Alphanumeric, 1J
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PPONumber | Reference number and Reference Qualifier |
Alphanumeric, 1M
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PayerID | Reference number and Reference Qualifier |
Alphanumeric, 2U
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | ProcessorIdentificationNumber | Reference number and Reference Qualifier |
Alphanumeric, ADI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | BINLocationNumber | Reference number and Reference Qualifier |
Alphanumeric, BO
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | Commercial | Reference number and Reference Qualifier |
Alphanumeric, C1
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | MedicalRecordIdentificationNumberEHR | Reference number and Reference Qualifier |
Alphanumeric, EA
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PatientAccountNumber | Reference number and Reference Qualifier |
Alphanumeric, EJ
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | DEANumber | Reference number and Reference Qualifier |
Alphanumeric, DH
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | HIN | Reference number and Reference Qualifier |
Alphanumeric, HI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | IndividualPolicyNumber | Reference number and Reference Qualifier |
Alphanumeric, IP
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | SecondaryCoverage | Reference number and Reference Qualifier |
Alphanumeric, NC
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | NAICCode | Reference number and Reference Qualifier |
Alphanumeric, NF
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PromotionNumber | Reference number and Reference Qualifier |
Alphanumeric, PD
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | SocialSecurity | Reference number and Reference Qualifier |
Alphanumeric, SY
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | NPI | Reference number and Reference Qualifier |
Alphanumeric, HPI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PriorAuthorization | Reference number and Reference Qualifier |
Alphanumeric, G1
|
AN | 35 | C | [ 0 .. 1 ] | ||
PVD-040 | Specialty | Agency 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.
|
AN | 10 | C | [ 0 .. 1 ] | 4709 | [ !-~]* |
PVD-070 | CliniclName | Party Name |
The clinic or pharmacy name in one field. |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050 | Name | Name |
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_TYPE | 129 | C | [ 0 .. 1 ] | ||
PVD-050-1002-01 | LastName | Last 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). |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050-1002-02 | FirstName | Fist Name |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050-1002-03 | MiddleName | Middle Name |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050-1002-04 | Suffix | Suffix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050-1002-05 | Prefix | Prefix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-080 | Address | Prescriber's Address |
The composite for the prescriber or pharmacist or supervisor address. Further defined fields are used for specific section of the address. |
ADDRESS_TYPE | 1120 | C | [ 0 .. 1 ] | ||
PVD-080-1 | AddressLine1 | Street and Number/P.O. Box |
Alphanumeric |
AN | 35 | R | [ 1 .. 1 ] | [ !-~]* |
|
PVD-080-2 | AddressLine2 | Street and Number/P.O. Box |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-080-3 | City | City Name |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-080-4 | State | Country Sub-entity identification |
United States and Canadian Province Postal Service Abbreviations. Values: See External Code List. |
AN | 2 | C | [ 0 .. 1 ] | AL|AK|AZ|AR|AS|CA|CO|CT|DE|DC| |
|
PVD-080-5 | ZipCode | Postcode Identification |
ZIP code of the pharmacy or prescriber. Use the format 99999 or 999999999. Is not to include hyphen (-). |
AN | 9 | C | [ 0 .. 1 ] | (\d{5})|(\d{9}) |
|
PVD-080-6 | PlaceLocationQualifier | Place/Location Qualifier |
Alphanumeric, free text. This field is locally defined "Agreement between trading partners if used." Should this be constrained and eliminated? |
AN | 999 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-090 | CommunicationNumbers | Communication 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_TYPE | 83 | R | [ 1 .. * ] | ||
PVD-090-1 | Number | Communication Number |
Telephone number, mandatory, max 80 length |
AN | 80 | R | [ 1 .. 1 ] | ([!-~]|[ ])*[!-~]([!-~]|[ ])* |
|
PVD-090-2 | Qualifier | Code 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
|
AN | 2 | C | [ 0 .. 1 ] | X-12 DE 365 | BN|CP|FX|HP|NP|TE|WP|EM |
PVD-100 | PrescriberAgent |
The order of this element is changed for the RXHRES structure. In NEWRX it appears before CommunicationNumbers |
NAME_TYPE | 129 | C | [ 0 .. 1 ] | |||
PVD-100-1 | LastName | Party Name |
Last name of the Designated Agent. This field is to be used in the 'PC' PVD Segment loop only.
|
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-100-2 | FirstName | First Name |
First name of the Designated Agent. |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-100-3 | MiddleName | Middle Name |
Middle name of the Designated Agent.. |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-100-4 | Suffix | Suffix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-100-5 | Prefix | Prefix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
PTT for RXHRES, all elements are optional
Reference | XML Reference | IG Reference | Notes | Type | Length | Usage | Cardinality | Value Set | Validation Pattern |
---|---|---|---|---|---|---|---|---|---|
PTT-010 | PatientRelationship | Individual Relationship, coded |
Defines the relationship of patient to cardholder.
|
AN | 1 | C | [ 0 .. 1 ] | External Code List | 1|2|3|4 |
PTT-050 | Identification | Reference number and Reference Qualifier |
The ordering of this element in the RXHRES - MedicationHistoryReponse XML is changed from NewPrecription/NEWRX.
|
ID_TYPE | 863 | C | [ 0 .. 2 ] | ||
Choice for PTT-050 | NCPDPID | Reference number and Reference Qualifier |
Alphanumeric, D3
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | FileID | Reference number and Reference Qualifier |
Alphanumeric, 94
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | StateLicenseNumber | Reference number and Reference Qualifier |
Alphanumeric, 0B
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | MedicareNumber | Reference number and Reference Qualifier |
Alphanumeric, 1C
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | MedicaidNumber | Reference number and Reference Qualifier |
Alphanumeric,1D
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | DentistLicenseNumber | Reference number and Reference Qualifier |
Alphanumeric, 1E
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | UPIN | Reference number and Reference Qualifier |
Alphanumeric, 1G
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | FacilityID | Reference number and Reference Qualifier |
Alphanumeric, 1J
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | PPONumber | Reference number and Reference Qualifier |
Alphanumeric, 1M
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | PayerID | Reference number and Reference Qualifier |
Alphanumeric, 2U
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | ProcessorIdentificationNumber | Reference number and Reference Qualifier |
Alphanumeric, ADI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | BINLocationNumber | Reference number and Reference Qualifier |
Alphanumeric, BO
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | Commercial | Reference number and Reference Qualifier |
Alphanumeric, C1
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | MedicalRecordIdentificationNumberEHR | Reference number and Reference Qualifier |
Alphanumeric, EA
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | PatientAccountNumber | Reference number and Reference Qualifier |
Alphanumeric number, (Qualifier= 'EJ')
|
AN | 35 | R | [ 1 .. 1 ] | ||
Choice for PTT-050 | DEANumber | Reference number and Reference Qualifier |
Alphanumeric, DH
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | HIN | Reference number and Reference Qualifier |
Alphanumeric, HI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | IndividualPolicyNumber | Reference number and Reference Qualifier |
Alphanumeric, IP
|
AN | 35 | RE | [ 0 .. 1 ] | ||
Choice for PTT-050 | SecondaryCoverage | Reference number and Reference Qualifier |
Alphanumeric, NC
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | NAICCode | Reference number and Reference Qualifier |
Alphanumeric, NF
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | PromotionNumber | Reference number and Reference Qualifier |
Alphanumeric, PD
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | SocialSecurity | Reference number and Reference Qualifier |
Alphanumeric, SY
|
AN | 35 | RE | [ 0 .. 1 ] | ||
Choice for PTT-050 | NPI | Reference number and Reference Qualifier |
Alphanumeric, HPI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PTT-050 | PriorAuthorization | Reference number and Reference Qualifier |
Alphanumeric, G1
|
AN | 35 | C | [ 0 .. 1 ] | ||
PT-030 | Name |
This composite is the name of the patient. Further defined fields separate the name into components. |
NAME_TYPE | 129 | C | [ 0 .. 1 ] | |||
PT-030-1 | LastName |
Last name of patient. |
AN | 35 | R | [ 1 .. 1 ] | [ !-~]* |
||
PT-030-2 | FirstName |
First name of the patient. |
AN | 35 | R | [ 1 .. 1 ] | [ !-~]* |
||
PT-030-3 | MiddleName |
Middlename should be specified if available. |
AN | 35 | RE | [ 0 .. 1 ] | [ !-~]* |
||
PT-030-4 | Suffix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
||
PT-030-5 | Prefix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
||
PTT-040 | Gender | Gender, coded |
Gender of the patient. X-12 DE 1069. Values: M = Male F = Female U = Unknown |
AN | 1 | C | [ 0 .. 1 ] | M|F|U |
|
PTT-020 | DateOfBirth |
This is s choice in XML- either date or date/time may be specified. |
DATE_TIME | 33 | C | [ 0 .. 1 ] | |||
Choice for PTT-020 | Date |
Birth Date of patient. Format: CCYYMMDD Note: Whenever possible, Birth Date of patient should be sent. |
DT | 8 | R | [ 1 .. 1 ] | ^\d{4}((0\d)|(1[0-2]))((([0-2] |
||
Choice for PTT-020 | Date/Time |
Date and Time |
DTM | 24 | C | [ 0 .. 1 ] | ^\d{4}(((0[1-9])|(1[0-2]))(((0 |
||
PTT-060 | Address |
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.
|
ADDRESS_TYPE | 1120 | C | [ 0 .. 1 ] | |||
PTT-060-1 | AddressLine1 | Street and Number/P.O. Box |
Street and Number/P.O. Box Note: Whenever possible, the patient address fields should be sent
|
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PTT-060-1 | AddressLine2 | Street and Number/P.O. Box |
Street and Number/P.O. Box Note: Whenever possible, the patient address fields should be sent |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PTT-060-2 | City | City Name |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PTT-060-3 | State | Country Sub-entity identification |
identification United States and Canadian Province Postal Service Abbreviations. Values: See External Code List. |
AN | 2 | C | [ 0 .. 1 ] | AL|AK|AZ|AR|AS|CA|CO|CT|DE|DC| |
|
PTT-060-4 | ZipCode | Postcode Identification |
Postal Code ZIP code of the pharmacy or prescriber. Use the format 99999 or 999999999. Is not to include hyphen (-). |
AN | 9 | C | [ 0 .. 1 ] | (\d{5})|(\d{9}) |
|
PTT-060-5 | PlaceLocationQualifier | Place/Location Qualifier |
Alphanumeric, free text. This field is locally defined "Agreement between trading partners if used." Should this be constrained and eliminated? |
AN | 999 | C | [ 0 .. 1 ] | [ !-~]* |
|
PTT-070 | CommunicationNumbers |
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_TYPE | 83 | C | [ 0 .. 1 ] | |||
PTT-070-1 | Number |
Telephone number, mandatory, max 80 length |
AN | 80 | R | [ 1 .. 1 ] | ([!-~]|[ ])*[!-~]([!-~]|[ ])* |
||
PTT-070-1 | Qualifier | Code 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.
|
AN | 2 | C | [ 0 .. 1 ] | BN|CP|FX|HP|NP|TE|WP|EM |
|
PTT-080 | PatientLocation |
Patient location elements order was changed for XML. Facility. --> Room --> Bed became Facility --> Bed --> Room. |
LOCATION_TYPE | 57 | C | [ 0 .. 1 ] | |||
PTT-080-1 | FacilityUnit | Facility Unit |
The unit of the patient. |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PTT-080-3 | Bed | Bed |
The bed of the patient. |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PTT-080-2 | Room | Room |
The room of the patient. |
AN | 10 | C | [ 0 .. 1 ] | ^\d{4}((0\d)|(1[0-2]))((([0-2] |
Benefit information used to determine plan and help identify the patient. Also contains the date range for the needed history records.
Reference | XML Reference | IG Reference | Notes | Type | Length | Usage | Cardinality | Value Set | Validation Pattern |
---|---|---|---|---|---|---|---|---|---|
COO-010 | PayerIdentification | Reference number and Reference Qualifier |
Choice of relevant identifiers is not restricted to those relevant to Payer identification.
|
ID_TYPE | 863 | C | [ 0 .. 2 ] | ||
Choice for COO-010 | NCPDPID | Reference number and Reference Qualifier |
Alphanumeric, D3
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | FileID | Reference number and Reference Qualifier |
Alphanumeric, 94
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | StateLicenseNumber | Reference number and Reference Qualifier |
Alphanumeric, 0B
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | MedicareNumber | Reference number and Reference Qualifier |
Alphanumeric, 1C
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | MedicaidNumber | Reference number and Reference Qualifier |
Alphanumeric,1D
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | DentistLicenseNumber | Reference number and Reference Qualifier |
Alphanumeric, 1E
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | UPIN | Reference number and Reference Qualifier |
Alphanumeric, 1G
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | FacilityID | Reference number and Reference Qualifier |
Alphanumeric, 1J
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | PPONumber | Reference number and Reference Qualifier |
Alphanumeric, 1M
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | PayerID | Reference number and Reference Qualifier |
Alphanumeric, 2U
|
AN | 35 | RE | [ 0 .. 1 ] | ||
Choice for COO-010 | ProcessorIdentificationNumber | Reference number and Reference Qualifier |
Alphanumeric, ADI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | BINLocationNumber | Reference number and Reference Qualifier |
Alphanumeric, BO
|
AN | 35 | RE | [ 0 .. 1 ] | ||
Choice for COO-010 | Commercial | Reference number and Reference Qualifier |
Alphanumeric, C1
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | MedicalRecordIdentificationNumberEHR | Reference number and Reference Qualifier |
Alphanumeric, EA
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | PatientAccountNumber | Reference number and Reference Qualifier |
Alphanumeric, EJ
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | DEANumber | Reference number and Reference Qualifier |
Alphanumeric, DH
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | HIN | Reference number and Reference Qualifier |
Alphanumeric, HI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | IndividualPolicyNumber | Reference number and Reference Qualifier |
Alphanumeric, IP
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | SecondaryCoverage | Reference number and Reference Qualifier |
Alphanumeric, NC
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | NAICCode | Reference number and Reference Qualifier |
Alphanumeric, NF
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | PromotionNumber | Reference number and Reference Qualifier |
Alphanumeric, PD
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | SocialSecurity | Reference number and Reference Qualifier |
Alphanumeric, SY
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | NPI | Reference number and Reference Qualifier |
Alphanumeric, HPI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for COO-010 | PriorAuthorization | Reference number and Reference Qualifier |
Alphanumeric, G1
|
AN | 35 | C | [ 0 .. 1 ] | ||
COO-020 | PayerName | Party Name |
Payer name CENSUS - if Private Pay ' This is the responsible Party Name. |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
COO-040 | ServiceTypeCoded | Service 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.
|
AN | 1 | C | [ 0 .. 1 ] | C |
|
COO-040 | CardHolderID | Reference Number |
Cardholder ID
|
AN | 35 | RE | [ 0 .. 1 ] | [ !-~]* |
|
COO-050 | ResponsibleParty | Party Name |
In NEWRX this field is used specify the full name of the "Card Holder". |
NAME_TYPE | 129 | C | [ 0 .. 1 ] | ||
COO-050-1 | LastName | Last Name |
Last name of the cardholder |
AN | 35 | RE | [ 0 .. 1 ] | [ !-~]* |
|
COO-050-2 | FirstName | First Name |
First name of the cardholder |
AN | 35 | R | [ 1 .. 1 ] | [ !-~]* |
|
COO-050-3 | MiddleName | Middle Name |
Middlename of the cardholder |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
COO-050-4 | Suffix | Suffix |
Suffix of the cardholder |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
COO-050-5 | Prefix | Prefix |
Prefix of the cardholder |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
COO-06-1154 | GroupID | Reference Number |
E |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
Choice for COO-090 | EffectiveDate |
Effective date - choice element |
DATE_TIME | 33 | C | [ 0 .. 1 ] | |||
Date |
Date |
DT | 8 | RE | [ 0 .. 1 ] | ^\d{4}((0\d)|(1[0-2]))((([0-2] |
|||
Date/Time |
Date and Time |
DTM | 0 | X | [ 0 .. 0 ] | ^\d{4}(((0[1-9])|(1[0-2]))(((0 |
|||
Choice for COO-090 | ExpirationDate |
Expiration date - choice element |
DATE_TIME | 33 | C | [ 0 .. 1 ] | |||
Date |
Date |
DT | 8 | RE | [ 0 .. 1 ] | ^\d{4}((0\d)|(1[0-2]))((([0-2] |
|||
Date/Time |
Date and Time |
DTM | 0 | X | [ 0 .. 0 ] | ^\d{4}(((0[1-9])|(1[0-2]))(((0 |
|||
COO-130 | Consent | Condition/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. |
AN | 1 | C | [ 0 .. 1 ] | Y|N|P|X|Z |
|
COO-140 | PBMMemberID | Patient Identifier |
Payer assigned Unique Member ID. |
AN | 80 | C | [ 0 .. 1 ] | [ !-~]* |
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.
Reference | XML Reference | IG Reference | Notes | Type | Length | Usage | Cardinality | Value Set | Validation Pattern |
---|---|---|---|---|---|---|---|---|---|
DRU-010-2 or DRU-10-12 | DrugDescription | Item 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.
|
AN | 105 | R | [ 1 .. 1 ] | [ !-~]* |
|
DRU-010-3 to 9 | DrugCoded | Item Number |
The "Drug number" refers ot the drug coded |
DRUG_CODE | 5143 | C | [ 0 .. 1 ] | ||
DRU-010-3 | ProductCode | Drug number |
RxNorm preferred product code.
|
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
DRU-010-4 | ProductCodeQualifier | Code List Responsibility Agency |
Coded: the code list defining the Item Number. X-12 DE 235.
|
AN | 2 | C | [ 0 .. 1 ] | X-12 DE 235 | ND|MF|UP |
DRU-010-6 | Strength | Free Text |
Measurement Value - Drug strength. Changed from field 6314 to 4440 in Version 4.0. Field length expanded to an..70. |
AN | 70 | C | [ 0 .. 1 ] | [ !-~]* |
|
DRU-010-8 | DrugDBCode | Reference Number |
GPI, GCN Seq #, GFC, DDID, SmartKey, GM, Multum MMDC, Multum Drug ID, etc |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
DRU-010-9 | DrugDBCodeQualifier | Reference Qualifier |
Code value to define the reference number. |
AN | 2 | C | [ 0 .. 1 ] | ND|MF|RT|UN|UP |
|
DRU-010-13 | FormSourceCode | Source Code List |
Code identifying the source organization. Required if Item Form Code (010-I013- 14-7992) used.
|
AN | 2 | C | [ 0 .. 1 ] | 7992 | AA |
DRU-010-14 | FormCode | Item Form Code |
Drug form, in a code. Dosage form code. Pharmaceutical Dosage Form. Qualified by Source Code List (7991). Values: See External Code List |
AN | 15 | C | [ 0 .. 1 ] | 7991 | [ !-~]* |
DRU-010-15 | StrengthSourceCode | Source Code List |
Code identifying the source organization. Required if Item Strength Code (010- I013-16-7993) used. Values: See External Code List |
AN | 2 | C | [ 0 .. 1 ] | 7993 | AB |
DRU-010-16 | StrengthCode | Item Strength Code |
Drug strength qualifier. Units of Presentation. Qualified by Source Code List (7991). Values: See External Code List |
AN | 15 | C | [ 0 .. 1 ] | 7991 | [ !-~]* |
DRU-010-17 | DEASchedule |
Code, the latest available at: http://evs.nci.nih.gov/ftp1/NCPDP/
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. |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
||
DRU-020 | Quantity | Quantity Composite |
This composite is for the count of tablets or number of grams. |
QUANTITY | 1030 | C | [ 0 .. 2 ] | ||
DRU-020-2 | Value | Quantity |
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'."
|
AN | 35 | R | [ 1 .. 1 ] | [0-9]+(\.[0-9]+)? |
|
DRU-020-3 | CodeListQualifier | Code 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.
|
AN | 2 | R | [ 1 .. 1 ] | X-12 DE 673 | 38|40|87|QS|CF |
DRU-020-4 | UnitSourceCode | Source Code List |
Alphanumeric, fixed in the XML "Code identifying the source organization. Required if Potency Unit Code (020-I009-05-7994) is used." |
AN | 2 | C | [ 0 .. 1 ] | AA|AB|AC |
|
DRU-020-4 | PotencyUnitCode | Potency Unit Code |
Unit of measure. Potency Unit. Qualified by Source Code List (7991).
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'. |
AN | 15 | C | [ 0 .. 1 ] | 7991 | [ !-~]* |
DRU-040 | DaysSupply | Date |
Note: It is strongly recommended that Days Supply (value 'ZDS' be supported.
|
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
DRU-030-2 and 3 | Directions | Dosage |
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).
|
AN | 140 | C | [ 0 .. 1 ] | [ !-~]* |
|
DRU-090 | Note | Free Text |
|
AN | 210 | C | [ 0 .. 1 ] | [ !-~]* |
|
DRU-060-1 | Refills/Qualifier | Quantity Qualifier |
This field does not appear in 10.11 because the qualifier is assumed to be 'R' in all cases for NEWRX.
|
AN | 3 | C | [ 0 .. 2 ] | R|PRN |
|
DRU-060-2 | Refills/Value | Quantity Value |
This element specifies the number of refills allowed.
|
AN | 35 | C | [ 0 .. 2 ] | [ !-~]* |
|
DRU-050 | Substitutions | Product/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) |
AN | 1 | C | [ 0 .. 1 ] | 0|1|2|3|4|5|7|8 |
|
DRU-040-2 (85) | WrittenDate | Date/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.
|
DATE_TIME | 33 | R | [ 1 .. 1 ] | ||
Choice for DRU-040-2 (85) | Date |
Date |
DT | 8 | C | [ 0 .. 1 ] | ^\d{4}((0\d)|(1[0-2]))((([0-2] |
||
Choice for DRU-040-2 (85) | Date/Time |
Date and Time |
DTM | 24 | C | [ 0 .. 1 ] | ^\d{4}(((0[1-9])|(1[0-2]))(((0 |
||
DRU-040 (LD) | LastFillDate | Date/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.
|
DATE_TIME | 33 | C | [ 0 .. 1 ] | ||
Choice for DRU-040 (LD) | Date |
Date |
DT | 8 | C | [ 0 .. 1 ] | ^\d{4}((0\d)|(1[0-2]))((([0-2] |
||
Choice for DRU-040 (LD) | Date/Time |
Date and Time |
DTM | 24 | C | [ 0 .. 1 ] | ^\d{4}(((0[1-9])|(1[0-2]))(((0 |
||
DRU-040 (36) | ExpirationDate | Date/Time/Period |
|
DATE_TIME | 33 | C | [ 0 .. 1 ] | ||
Choice for DRU-040 (36) | Date |
Date |
DT | 8 | C | [ 0 .. 1 ] | ^\d{4}((0\d)|(1[0-2]))((([0-2] |
||
Choice for DRU-040 (36) | Date/Time |
Date and Time |
DTM | 24 | C | [ 0 .. 1 ] | ^\d{4}(((0[1-9])|(1[0-2]))(((0 |
||
DRU-040 (07) | EffectiveDate | Date/Time/Period |
|
DATE_TIME | 33 | C | [ 0 .. 1 ] | ||
Choice for DRU-040 (07) | Date |
Date |
DT | 8 | C | [ 0 .. 1 ] | ^\d{4}((0\d)|(1[0-2]))((([0-2] |
||
Choice for DRU-040 (07) | Date/Time |
Date and Time |
DTM | 24 | C | [ 0 .. 1 ] | ^\d{4}(((0[1-9])|(1[0-2]))(((0 |
||
DRU-040 (PE) | PeriodEnd | Date/Time/Period |
|
DATE_TIME | 33 | C | [ 0 .. 1 ] | ||
Choice for DRU-040 (PE) | Date |
Date |
DT | 8 | C | [ 0 .. 1 ] | ^\d{4}((0\d)|(1[0-2]))((([0-2] |
||
Choice for DRU-040 (PE) | Date/Time |
Date and Time |
DTM | 24 | C | [ 0 .. 1 ] | ^\d{4}(((0[1-9])|(1[0-2]))(((0 |
||
DRU-040 (35) | DeliveredOnDate | Date/Time/Period |
|
DATE_TIME | 33 | C | [ 0 .. 1 ] | ||
Choice for DRU-040 (35) | Date |
Date |
DT | 8 | C | [ 0 .. 1 ] | ^\d{4}((0\d)|(1[0-2]))((([0-2] |
||
Choice for DRU-040 (35) | Date/Time |
Date and Time |
DTM | 24 | C | [ 0 .. 1 ] | ^\d{4}(((0[1-9])|(1[0-2]))(((0 |
||
DRU-040 (BE) | DateValidated | Date/Time/Period |
|
DATE_TIME | 33 | C | [ 0 .. 1 ] | ||
Choice for DRU-040 (BE) | Date |
Date |
DT | 8 | C | [ 0 .. 1 ] | ^\d{4}((0\d)|(1[0-2]))((([0-2] |
||
Choice for DRU-040 (BE) | Date/Time |
Date and Time |
DTM | 24 | C | [ 0 .. 1 ] | ^\d{4}(((0[1-9])|(1[0-2]))(((0 |
||
DRU-070 | Diagnosis |
This structure allows senders to specify two sets of primary and secondary diagnoses.
|
DIAGNOSIS | 999 | C | [ 0 .. 2 ] | |||
DRU-070-1 | ClinicalInformationQualifier | Clinical Information Qualifier |
Qualifies the Clinical Information - primary field. Values: See External Code List |
AN | 1 | R | [ 1 .. 1 ] | 1|2 |
|
DRU-070-2 | PrimaryDiagnosis | Clinical Information - primary | DIAGNOSIS_TYPE | 21 | R | [ 1 .. 1 ] | |||
DRU-070-4 | Qualifier | Code 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
|
AN | 3 | C | [ 0 .. 1 ] | E|F|M|ABF|DX|ICD9|ICD10 |
|
DRU-070-5 | Value |
The prescriber supplied or pharmacy inferred code for the diagnosis, coded |
AN | 17 | R | [ 1 .. 1 ] | ([!-~]|[ ])*[!-~]([!-~]|[ ])* |
||
DRU-070-4 | SecondaryDiagnosis | Clinical Information - secondary | DIAGNOSIS_TYPE | 0 | X | [ 0 .. 0 ] | |||
DRU-070-4 | Qualifier | Code 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
|
AN | 3 | O | [ 0 .. 1 ] | X-12 DE 235 | E|F|M|ABF|DX|ICD9|ICD10 |
DRU-070-5 | Value |
The prescriber supplied or pharmacy inferred code for the secondary diagnosis., coded |
AN | 17 | R | [ 1 .. 1 ] | ([!-~]|[ ])*[!-~]([!-~]|[ ])* |
||
DRU-080-2 | PriorAuthorization | Reference Number | AUTHORIZATION | 45 | C | [ 0 .. 1 ] | |||
DRU-080-2 | Qualifier | Reference 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 |
AN | 1 | C | [ 0 .. 1 ] | G1|PD|D3|94|0B|1C|1D|1E|1G|1M| |
|
DRU-080-1 | Value |
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. |
AN | 35 | R | [ 1 .. 1 ] | [ !-~]* |
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.
Reference | XML Reference | IG Reference | Notes | Type | Length | Usage | Cardinality | Value Set | Validation Pattern |
---|---|---|---|---|---|---|---|---|---|
PVD-020 | Identification | Reference 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).
|
ID_TYPE | 863 | R | [ 1 .. 10 ] | ||
Choice for PVD-020 | NCPDPID | Reference number and Reference Qualifier |
Alphanumeric, D3
|
AN | 35 | R | [ 1 .. 1 ] | ||
Choice for PVD-020 | FileID | Reference number and Reference Qualifier |
Alphanumeric, 94
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | StateLicenseNumber | Reference number and Reference Qualifier |
Alphanumeric, 0B
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | MedicareNumber | Reference number and Reference Qualifier |
Alphanumeric, 1C
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | MedicaidNumber | Reference number and Reference Qualifier |
Alphanumeric,1D
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | DentistLicenseNumber | Reference number and Reference Qualifier |
Alphanumeric, 1E
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | UPIN | Reference number and Reference Qualifier |
Alphanumeric, 1G
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | FacilityID | Reference number and Reference Qualifier |
Alphanumeric, 1J
Not applicable |
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PPONumber | Reference number and Reference Qualifier |
Alphanumeric, 1M
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PayerID | Reference number and Reference Qualifier |
Alphanumeric, 2U
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | ProcessorIdentificationNumber | Reference number and Reference Qualifier |
Alphanumeric, ADI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | BINLocationNumber | Reference number and Reference Qualifier |
Alphanumeric, BO
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | Commercial | Reference number and Reference Qualifier |
Alphanumeric, C1
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | MedicalRecordIdentificationNumberEHR | Reference number and Reference Qualifier |
Alphanumeric, EA
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PatientAccountNumber | Reference number and Reference Qualifier |
Alphanumeric, EJ
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | DEANumber | Reference number and Reference Qualifier |
Alphanumeric, DH
|
AN | 35 | R | [ 1 .. 1 ] | ||
Choice for PVD-020 | HIN | Reference number and Reference Qualifier |
Alphanumeric, HI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | IndividualPolicyNumber | Reference number and Reference Qualifier |
Alphanumeric, IP
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | SecondaryCoverage | Reference number and Reference Qualifier |
Alphanumeric, NC
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | NAICCode | Reference number and Reference Qualifier |
Alphanumeric, NF
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PromotionNumber | Reference number and Reference Qualifier |
Alphanumeric, PD
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | SocialSecurity | Reference number and Reference Qualifier |
Alphanumeric, SY
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | NPI | Reference number and Reference Qualifier |
Alphanumeric, HPI
Applicable in this case |
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PriorAuthorization | Reference number and Reference Qualifier |
Alphanumeric, G1
|
AN | 35 | C | [ 0 .. 1 ] | ||
PVD-040 | Specialty | Agency 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 |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050 | Pharmacist | Name |
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_TYPE | 129 | C | [ 0 .. 1 ] | ||
PVD-050-1 | LastName | Last Name |
Since this field is marked CM - this component is required. This assumption should apply to any mandatory composite field. |
AN | 35 | R | [ 1 .. 1 ] | [ !-~]* |
|
PVD-050-2 | FirstName | First Name |
First name required if the Phamacist's name is required. |
AN | 35 | R | [ 1 .. 1 ] | [ !-~]* |
|
PVD-050-3 | MiddleName | Middle Name |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050-3 | Suffix | Suffix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050-5 | Prefix | Prefix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-070 | StoreName | Party Name |
The clinic or pharmacy name in one field.
|
AN | 35 | R | [ 1 .. 1 ] | [ !-~]* |
|
PVD-080 | Address | Address |
The composite for the prescriber or pharmacist or supervisor address. Further defined fields are used for specific section of the address. |
ADDRESS_TYPE | 1120 | C | [ 0 .. 1 ] | ||
PVD-080-1 | AddressLine1 | Street and Number/P.O. Box |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-080-2 | AddressLine2 | Street and Number/P.O. Box |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-080-3 | City | City Name |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-080-4 | State | Country Sub-entity identification |
United States and Canadian Province Postal Service Abbreviations. Values: See External Code List. |
AN | 2 | C | [ 0 .. 1 ] | AL|AK|AZ|AR|AS|CA|CO|CT|DE|DC| |
|
PVD-080-5 | ZipCode | Postcode Identification |
ZIP code of the pharmacy or prescriber. Use the format 99999 or 999999999. Is not to include hyphen (-). |
AN | 9 | C | [ 0 .. 1 ] | (\d{5})|(\d{9}) |
|
PVD-080-6 | PlaceLocationQualifier | Place/Location Qualifier |
Alphanumeric, free text. This field is locally defined "Agreement between trading partners if used." Should this be constrained and eliminated? |
AN | 999 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-090 | CommunicationNumbers | Communication 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_TYPE | 83 | R | [ 1 .. * ] | ||
PVD-090-1 | Number | Communication Number |
Telephon number, mandatory, max 80 length |
AN | 80 | R | [ 1 .. 1 ] | ([!-~]|[ ])*[!-~]([!-~]|[ ])* |
|
PVD-090-2 | Qualifier | Code 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
|
AN | 2 | C | [ 0 .. 1 ] | BN|CP|FX|HP|NP|TE|WP|EM |
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.
Reference | XML Reference | IG Reference | Notes | Type | Length | Usage | Cardinality | Value Set | Validation Pattern |
---|---|---|---|---|---|---|---|---|---|
PVD-020 | Identification | Reference 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)
|
ID_TYPE | 863 | R | [ 1 .. 10 ] | ||
Choice for PVD-020 | NCPDPID | Reference number and Reference Qualifier |
Alphanumeric, D3
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | FileID | Reference number and Reference Qualifier |
Alphanumeric, 94
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | StateLicenseNumber | Reference number and Reference Qualifier |
Alphanumeric, 0B
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | MedicareNumber | Reference number and Reference Qualifier |
Alphanumeric, 1C
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | MedicaidNumber | Reference number and Reference Qualifier |
Alphanumeric,1D
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | DentistLicenseNumber | Reference number and Reference Qualifier |
Alphanumeric, 1E
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | UPIN | Reference number and Reference Qualifier |
Alphanumeric, 1G
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | FacilityID | Reference number and Reference Qualifier |
Alphanumeric, 1J
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PPONumber | Reference number and Reference Qualifier |
Alphanumeric, 1M
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PayerID | Reference number and Reference Qualifier |
Alphanumeric, 2U
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | ProcessorIdentificationNumber | Reference number and Reference Qualifier |
Alphanumeric, ADI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | BINLocationNumber | Reference number and Reference Qualifier |
Alphanumeric, BO
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | Commercial | Reference number and Reference Qualifier |
Alphanumeric, C1
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | MedicalRecordIdentificationNumberEHR | Reference number and Reference Qualifier |
Alphanumeric, EA
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PatientAccountNumber | Reference number and Reference Qualifier |
Alphanumeric, EJ
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | DEANumber | Reference number and Reference Qualifier |
Alphanumeric, DH
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | HIN | Reference number and Reference Qualifier |
Alphanumeric, HI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | IndividualPolicyNumber | Reference number and Reference Qualifier |
Alphanumeric, IP
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | SecondaryCoverage | Reference number and Reference Qualifier |
Alphanumeric, NC
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | NAICCode | Reference number and Reference Qualifier |
Alphanumeric, NF
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PromotionNumber | Reference number and Reference Qualifier |
Alphanumeric, PD
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | SocialSecurity | Reference number and Reference Qualifier |
Alphanumeric, SY
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | NPI | Reference number and Reference Qualifier |
Alphanumeric, HPI
|
AN | 35 | C | [ 0 .. 1 ] | ||
Choice for PVD-020 | PriorAuthorization | Reference number and Reference Qualifier |
Alphanumeric, G1
|
AN | 35 | C | [ 0 .. 1 ] | ||
PVD-040 | Specialty | Agency 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.
|
AN | 10 | C | [ 0 .. 1 ] | 4709 | [ !-~]* |
PVD-070 | CliniclName | Party Name |
The clinic or pharmacy name in one field. |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050 | Name | Name |
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_TYPE | 129 | R | [ 1 .. 1 ] | ||
PVD-050-1002-01 | LastName | Last 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). |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050-1002-02 | FirstName | Fist Name |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050-1002-03 | MiddleName | Middle Name |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050-1002-04 | Suffix | Suffix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-050-1002-05 | Prefix | Prefix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-080 | Adders | Prescriber's Address |
The composite for the prescriber or pharmacist or supervisor address. Further defined fields are used for specific section of the address. |
ADDRESS_TYPE | 1120 | R | [ 1 .. 1 ] | ||
PVD-080-1 | AddressLine1 | Street and Number/P.O. Box |
Alphanumeric |
AN | 35 | R | [ 1 .. 1 ] | [ !-~]* |
|
PVD-080-2 | AddressLine2 | Street and Number/P.O. Box |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-080-3 | City | City Name |
Alphanumeric |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-080-4 | State | Country Sub-entity identification |
United States and Canadian Province Postal Service Abbreviations. Values: See External Code List. |
AN | 2 | C | [ 0 .. 1 ] | AL|AK|AZ|AR|AS|CA|CO|CT|DE|DC| |
|
PVD-080-5 | ZipCode | Postcode Identification |
ZIP code of the pharmacy or prescriber. Use the format 99999 or 999999999. Is not to include hyphen (-). |
AN | 9 | C | [ 0 .. 1 ] | (\d{5})|(\d{9}) |
|
PVD-080-6 | PlaceLocationQualifier | Place/Location Qualifier |
Alphanumeric, free text. This field is locally defined "Agreement between trading partners if used." Should this be constrained and eliminated? |
AN | 999 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-100 | PrescriberAgent |
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_TYPE | 129 | C | [ 0 .. 1 ] | |||
PVD-100-1 | LastName | Party Name |
Last name of the Designated Agent. This field is to be used in the 'PC' PVD Segment loop only.
|
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-100-2 | FirstName | First Name |
First name of the Designated Agent. |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-100-3 | MiddleName | Middle Name |
Middle name of the Designated Agent.. |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-100-4 | Suffix | Suffix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-100-5 | Prefix | Prefix |
Alphanumeric |
AN | 10 | C | [ 0 .. 1 ] | [ !-~]* |
|
PVD-090 | CommunicationNumbers | Communication 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_TYPE | 83 | R | [ 1 .. * ] | ||
PVD-090-1 | Number | Communication Number |
Telephone number, mandatory, max 80 length |
AN | 80 | R | [ 1 .. 1 ] | ([!-~]|[ ])*[!-~]([!-~]|[ ])* |
|
PVD-090-2 | Qualifier | Code 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
|
AN | 2 | C | [ 0 .. 1 ] | X-12 DE 365 | BN|CP|FX|HP|NP|TE|WP|EM |
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.
Reference | XML Reference | IG Reference | Notes | Type | Length | Usage | Cardinality | Value Set | Validation Pattern |
---|---|---|---|---|---|---|---|---|---|
DRU-100 CPD-030 | DrugUseEvaluation |
Conditional repeating composite for further explanation, conflict, or clarification of services related to drug use evaluation |
DRUG_USE_EVAL | 112 | C | [ 0 .. 5 ] | |||
DRU-100-1 | ServiceReasonCode | DUE 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. |
AN | 2 | R | [ 1 .. 1 ] | AD|AN|AR|AT|CD|CH|CS|DA|DC|DD| |
|
DRU-100-2 | ProfessionalServiceCode | DUE 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. |
AN | 2 | C | [ 0 .. 1 ] | 00|AS|CC|DE|DP|FE|GP|MA|MB|MP| |
|
DRU-100-3 | ServiceResultCode | DUE 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. |
AN | 2 | C | [ 0 .. 1 ] | 00|1A|1B|1C|1D|1E|1F|1G|1H|1J| |
|
DRU-100-4 and DRU-100-5 | CoAgent | DUE 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. |
COAGENT | 0 | X | [ 0 .. 0 ] | ||
DRU-100-5 | CoAgentIdentifier | DUE Co-Agent ID Qualifier |
Alphanumeric |
AN | 19 | O | [ 0 .. 1 ] | [ !-~]* |
|
DRU-100-5 | CoAgentQualifier | DUE 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. |
AN | 2 | O | [ 0 .. 1 ] | 1|02|03|04|05|07|08|09|11|12|1 |
|
DRU-100-6 | ClinicalSignificanceCode | DUE Clinical Significance Code |
Alphanumeric, pattern Code identifying the significance or severity level of a clinical event as contained in the originating database. |
AN | 1 | C | [ 0 .. 1 ] | 1|2|3|9 |
|
DRU-100-07 | AcknowledgementReason | DUE 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 |
AN | 100 | C | [ 0 .. 1 ] | [ !-~]* |
|
DRU-110 | DrugCoverageStatus | Drug Coverage Status Code |
Code identifying the coverage status of the prescribed drug. Predicate:This field should only be used for medication prescribed. |
AN | 2 | C | [ 0 .. 5 ] | PR|AP|PA|NF|NR|DC|UN|ST|SI |
|
DRU-120 | PriorAuthorizationStatus | Prior Authorization Status |
The status of the prescription's prior authorization as known by the sender. |
AN | 1 | C | [ 0 .. 1 ] | A|D|R|N|F |
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.
Reference | XML Reference | IG Reference | Notes | Type | Length | Usage | Cardinality | Value Set | Validation Pattern |
---|---|---|---|---|---|---|---|---|---|
SIG-010 | RepeatingSIG | REPEATING 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_SEQUENCE | 7 | R | [ 1 .. 1 ] | ||
SIG-010-1 | SigSequencePositionNumber |
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. |
N | 2 | R | [ 1 .. 1 ] | [0-9]+(\.[0-9]+)? |
||
SIG-010-2 | MultipleModifier |
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. |
AN | 4 | C | [ 0 .. 1 ] | AND|OR|THEN |
||
SIG-020 | CodeSystem | CODE SYSTEM |
The Code System Composite of the Sig identifies which code system and version are used. |
CODE_SYSTEM | 29 | R | [ 1 .. 1 ] | ||
SIG-020-1 | SNOMEDVersion |
The version of The Systematized Nomenclature of Human and Veterinary Medicine (SNOMED) being used. |
AN | 14 | C | [ 0 .. 1 ] | [ !-~]* |
||
SIG-020-2 | FMTVersion |
The version of Federal Medication Terminologies (FMT) being used. |
AN | 14 | C | [ 0 .. 1 ] | [ !-~]* |
||
SIG-030 | FreeText | Sig 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_TEXT | 142 | R | [ 1 .. 1 ] | ||
SIG-030-1 | SigFreeTextStringIndicator | Sig 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. |
AN | 1 | R | [ 1 .. 1 ] | 1|2|3 |
|
SIG-030-2 | SigFreeText | Sig Free Text |
Sig Free Text |
AN | 140 | R | [ 1 .. 1 ] | [ !-~]* |
|
SIG-040 | Dose | DOSE |
The dose composite can define a fixed dose or can repeat to define a variable dose, dose range, or dose options. |
DOSE | 230 | R | [ 1 .. 1 ] | ||
SIG-040-1 | DoseCompositeIndicator | Dose Composite Indicator |
Alphanumeric, pattern 1|2|3|4 Indicates the action to be taken on the Dose Composite fields. |
AN | 1 | C | [ 0 .. 1 ] | 1|2|3|4 |
|
SIG-040-2 | DoseDeliveryMethodText | Dose 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) |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-040-3 | DoseDeliveryMethodCodeQualifier | Dose Delivery Method Code Qualifier |
Alphanumeric, pattern 1|2 Qualifier to identify the code system being used |
AN | 1 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-040-4 | DoseDeliveryMethodCode | Dose Delivery Method Code |
The code representing the Dose Delivery Method Text. |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-040-5 | DoseDeliveryMethodModifierText | Dose Delivery Method Modifier Text |
Modifies the method in which the dose is delivered (clarifies Dose Delivery Method Text). |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-040-6 | DoseDeliveryMethodModifierCodeQualifier | Dose Delivery Method Modifier Code Qualifier |
Qualifier to identify the code system being used. Values: See External Code List |
AN | 1 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-040-7 | DoseDeliveryMethodModifierCode | Dose Delivery Method Modifier Code |
The code representing the Dose Delivery Method Modifier Text. |
AN | 15 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-040-8 | DoseQuantity | Dose Quantity |
The numeric expression of the dose. |
N | 18 | C | [ 0 .. 1 ] | [0-9]+(\.[0-9]+)? |
|
SIG-040-9 | DoseFormText | Dose Form Text |
The textual representation of the Dose Form |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-040-10 | DoseFormQualifier | Dose Form Code Qualifier |
Qualifier to identify the code system being used. Values: See External Code List |
AN | 0 | X | [ 0 .. 0 ] | 1|2 |
|
SIG-040-11 | DoseFormCode | Dose Form Code |
The code representing the Dose Form |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-040-12 | DoseRangeModifier | Dose 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 |
AN | 3 | C | [ 0 .. 1 ] | TO|OR |
|
SIG-050 | DoseCalculation | DOSE 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_CALC | 198 | C | [ 0 .. 1 ] | ||
SIG-050-1 | DosingBasisNumericValue | Dosing Basis Numeric Value |
Expresses the numeric value of the dosing basis. |
N | 18 | C | [ 0 .. 1 ] | [0-9]+(\.[0-9]+)? |
|
SIG-050-2 | DosisBasisUnitofMeasureText | Dosing Basis Unit of Measure Text |
The textual representation of the dosing basis unit of measure. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-050-3 | DosingBasisUnitofMeasureCodeQualifier | Dosing Basis Unit of Measure Code Qualifier |
Alphanumeric, pattern 1|2 Qualifier to identify the code system being used. |
AN | 1 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-050-4 | DosingBasisUnitofMeasureCode | Dosing Basis Unit of Measure Code |
The code representing the dosing basis unit of measure |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-050-5 | BodyMetricQualifier | Body Metric Qualifier |
Alphanumeric, pattern 1|2 Qualifier to identify the body metric being used (either weight or surface area). Values: See External Code List |
AN | 0 | X | [ 0 .. 0 ] | 1|2 |
|
SIG-050-6 | BodyMetricValue | Body Metric Value |
Numeric Expresses the value of the body metric. |
N | 18 | C | [ 0 .. 1 ] | [0-9]+(\.[0-9]+)? |
|
SIG-050-7 | CalculateDoseNumeric | Calculated Dose Numeric |
Numeric Expresses the numeric value of the calculated dose |
N | 18 | C | [ 0 .. 1 ] | [0-9]+(\.[0-9]+)? |
|
SIG-050-8 | CalculateDoseUnitofMeasureText | Calculated Dose Unit of Measure Text |
The textual representation of the unit of measure of the calculated dose. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-050-9 | CalcuateDoseUnitofMeasureCodeQualifier | Calculated Dose Unit of Measure Code Qualifier |
Alphanumeric, pattern 1|2 Qualifier to identify the code system being used. Values: See External Code List |
AN | 1 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-050-10 | CalculateDoseUnitofMeasureCode | Calculated Dose Unit of Measure Code |
Code representing the calculated dose unit of measure. |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-050-11 | DosingBasisRangeModifier | Dosing 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 |
AN | 2 | C | [ 0 .. 1 ] | TO|PR |
|
SIG-060 | Vehicle | VEHICLE COMPOSITE |
Defines a vehicle specified for the delivery of the product. |
VEHICLE | 160 | C | [ 0 .. 1 ] | ||
SIG-060-1 | VehicleName | Vehicle Name | AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
||
SIG-050-2 | VehicleNameCodeQualifier | Vehicle Name Code Qualifier |
Alphanumeric, pattern 1|2 Vehicle Name Code Qualifier |
AN | 1 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-060-3 | VehicleNameCode | Vehicle Name Code |
The code representing the Vehicle Name. |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-060-4 | VehicleQuantity | Vehicle Quantity |
A volume, expressed in a value. |
N | 18 | C | [ 0 .. 1 ] | [0-9]+(\.[0-9]+)? |
|
SIG-060-5 | VehicleUnitOfMeasureText | Vehicle Unit Of Measure Text |
The textual representation of Vehicle Unit of Measure. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-060-6 | VehicleUnitOfMeasureCodeQualifier | Vehicle Unit Of Measure Code Qualifier |
Alphanumeric, pattern 1|2 Qualifier to identify the code system being used. Values: See External Code List |
AN | 1 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-060-7 | VehicleUnitOfMeasureCode | Vehicle Unit Of Measure Code |
The code representing the Vehicle Unit of Measure |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-050-8 | MultipleVehicleModifier | Multiple 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 |
AN | 3 | C | [ 0 .. 1 ] | AND|OR |
|
SIG-070 | RouteofAdministration | ROUTE OF ADMINISTRATION COMPOSITE |
Defines the route of administration. |
ROUTE | 72 | C | [ 0 .. 1 ] | ||
SIG-070-1 DRU-180-1 | RouteofAdministrationText | Route of Administration Text |
Alphanumeric, free text, The textual representation of the Route of Administration |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-070-2 DRU-180 | RouteofAdministrationCodeQualifier | Route of Administration Code Qualifier |
Qualifier to identify the code system being used. Route of Administration Code Qualifier |
AN | 1 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-070-3 DRU-180-3 | RouteofAdministratoinCode | Route of Administration Code |
The code representing the Route of Administration |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-070-4 DRU-180-4 | MultipleRouteofAdministrationModifier | Multiple 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 |
AN | 3 | C | [ 0 .. 1 ] | AND|OR |
|
SIG-080 | SiteofAdministration | SITE OF ADMINISTRATION COMPOSITE | Predicate: Defines the site of administration. |
SITE | 72 | C | [ 0 .. 1 ] | ||
SIG-080-1 | SiteofAdministrationText | Site of Administration Text |
The textual representation of Site Code. It is the site of administration. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-080-2 | SiteofAdministrationCodeQualifier | Site of Administration Code Qualifier |
Qualifier to identify the code system being used. |
AN | 1 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-080-3 | SiteofAdministrationCode | Site of Administration Code |
The code representing the Site of Administration |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-080-4 | MultipleAdministrationTimingModifier | Multiple 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). |
AN | 3 | C | [ 0 .. 1 ] | AND|OR|NOT |
|
SIG-090 | Timing | Sig 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
|
TIMING | 399 | C | [ 0 .. 1 ] | ||
SIG-090-1 | AdministrationTimingText | Administration Timing Text |
The textual representation of Administration Timing. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-090-2 | AdministrationTimingCodeQualifier | Administration Timing Code Qualifier |
Qualifier to identify the code system being used. |
AN | 1 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-090-3 | AdministrationTimingCode | Administration Timing Code |
The code representing the Administration Timing Text. |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-090-4 | MultipleAdministrationTimingModifier | Multiple 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 |
AN | 3 | C | [ 0 .. 1 ] | AND|OR |
|
SIG-090-5 | RateofAdministration | Rate of Administration |
The amount of time for a {single} dose to be administered |
AN | 11 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-090-6 | RateUnitofMeasureText | Rate 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. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-090-7 | RateUnitofMeasureCodeQualifier | Rate Unit of Measure Code Qualifier |
Alphanumeric, pattern 1|2 Qualifier to identify the code system being used. |
AN | 1 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-090-8 | RateUnitofMeasureCode | Rate Unit of Measure Code |
The code representing the Rate Unit Of Measure Text. |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-090-9 | TimePeriodBasisText | Time Period Basis Text |
Expresses the time unit of measure for the calculated dose. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-090-10 | TimePeriodBasisCodeQualifier | Time Period Basis Code Qualifier |
Alphanumeric, pattern 1|2 Qualifier to identify the code system being used. |
AN | 1 | C | [ 0 .. 1 ] | External Code List | 1|2 |
SIG-090-11 | TimePeriodBasisCode | Time Period Basis Code |
The code representing the time period basis. |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-090-12 | FrequenceNumericValue | Frequency 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. |
AN | 11 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-090-13 | FrequencyUnitsText | Frequency Units Text |
The textual representation of Frequency Units Code. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-090-14 | FrequencyUnitsCodeQualifier | Frequency Units Code Qualifier |
Alphanumeric, pattern 1|2 Qualifier to identify the code system being used. |
AN | 1 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-090-15 | FrequencyUnitsCode | Frequency Units Code |
The code represented by Frequency Units Text. |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-090-16 | VariableFrequencyModifier | Variable 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). |
AN | 3 | C | [ 0 .. 1 ] | AND|OR|TO |
|
SIG-090-17 | IntervalNumericValue | Interval Numeric Value |
Numeric Defines an interval of administration. Interval is the time between events. |
N | 18 | C | [ 0 .. 1 ] | [0-9]+(\.[0-9]+)? |
|
SIG-090-18 | IntervalUnitsText | Interval Units Text |
The textual representation of Interval Units Code. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-090-19 | IntervalUnitsCodeQualifier | Interval Units Code Qualifier |
Qualifier to identify the code system being used. |
AN | 1 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-090-20 | IntervalUnitsCode | Interval Units Code |
The code representing the Interval Units Text. |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-090-21 | VariableIntervalModifier | Variable 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 |
AN | 3 | C | [ 0 .. 1 ] | AND|OR|TO |
|
SIG-100 | Duration | DURATION COMPOSITE |
Defines a duration of use/therapy. |
DURATION | 80 | C | [ 0 .. 1 ] | ||
SIG-100-1 | DurationNumericValue | Duration Numeric Value |
Numeric The numeric duration units. |
N | 11 | R | [ 1 .. 1 ] | [0-9]+(\.[0-9]+)? |
|
SIG-100-2 | DurationText | Duration Text |
Alphanumeric The textual representation of Duration Units Code. |
AN | 50 | R | [ 1 .. 1 ] | [ !-~]* |
|
SIG-100-3 | DurationTextCodeQualifier | Duration Text Code Qualifier |
Qualifier to identify the code system being used. |
AN | 1 | R | [ 1 .. 1 ] | 1|2 |
|
SIG-100-4 | DurationTextCode | Duration Text Code |
The code representing the Duration Units Text. |
AN | 15 | R | [ 1 .. 1 ] | [ !-~]* |
|
SIG-110 | MaximumDoseRestriction | MAXIMUM DOSE RESTRICTION COMPOSITE |
The dose restriction composite of the Sig which defines a maximum or dose limit, as specified by the prescriber. |
MAX_DOSE | 179 | R | [ 1 .. 1 ] | ||
MaximumDoseRestrictionNumericValue | Maximum 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. |
N | 18 | R | [ 1 .. 1 ] | [0-9]+(\.[0-9]+)? |
||
SIG-110-2 | MaximumDoseRestrictionUnitsText | Maximum Dose Restriction Units Text |
The textual representation of the Dose Maximum Units. |
AN | 50 | R | [ 1 .. 1 ] | [ !-~]* |
|
SIG-110-3 | MaximumDoseRestrictionCodeQualifier | Maximum Dose Restriction Code Qualifier |
Qualifier 1, 2 Qualifier to identify the code system being used. Values: See External Code List |
AN | 1 | R | [ 1 .. 1 ] | 1|2 |
|
SIG-110-4 | MaximumDoseRestrictionUnitsCode | Maximum Dose Restriction Units Code |
The code representing the Dose Maximum Units Text. |
AN | 15 | R | [ 1 .. 1 ] | [ !-~]* |
|
SIG-110-5 | MaximumDoseRestrictionVariableNumericValue | Maximum Dose Restriction Variable Numeric Value |
Numeric The numeric representation of the maximum dose calculations. |
N | 18 | C | [ 0 .. 1 ] | [0-9]+(\.[0-9]+)? |
|
SIG-110-6 | MaximumDoseRestrictionVariableUnitsText | Maximum Dose Restriction Variable Units Text |
The textual representation of the Dose Maximum Variable Units. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-110-7 | MaximumDoseRestrictionVariableUnitsCodeQualifier | Maximum 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 |
AN | 1 | C | [ 0 .. 1 ] | 1|2 |
|
SIG-110-8 | MaximumDoseRestrictionVariableUnitsCode | Maximum 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. |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-110-9 | MaximumDoseRestrictionVariableDurationModifier | Maximum 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 |
AN | 3 | C | [ 0 .. 1 ] | AND|OR |
|
SIG-120 | Indication | INDICATION COMPOSITE |
Defines the indication for use of the medication as meant to be conveyed to the patient. |
INDICATION | 295 | R | [ 1 .. 1 ] | ||
SIG-120-1 | IndicationPrecursorText | Indication Precursor Text |
The textual representation of the indication precursor. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-120-3 | IndicationPrecursoCodeQualifier | Indication Precursor Code Qualifier |
Qualifier 1, 2 Qualifier to identify the code system being used. Values: See External Code List |
AN | 1 | C | [ 0 .. 1 ] | External Code List | 1|2 |
SIG-120-3 | IndicationPrecursorCode | Indication Precursor Code |
The code representing the indication precursor. |
AN | 15 | R | [ 1 .. 1 ] | [ !-~]* |
|
SIG-120-4 | IndicationText | Indication Text |
The textual representation of the Indication. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-120-5 | IndicationTextCodeQualifier | Indication Text Code Qualifier |
Qualifier 1,2 Qualifier to identify the code system being used. Values: See External Code List |
AN | 1 | C | [ 0 .. 1 ] | External Code List | 1|2 |
SIG-120-6 | IndicationTextCode | Indication Text Code |
The code representing the Indication Text. |
AN | 15 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-120-7 | IndicationValueText | Indication Value Text |
The textual representation of when the indication value is applicable. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-120-8 | IndicatoinValueUnit | Indication Value Unit |
The numeric expression of a value when it applies to an Indication. |
AN | 18 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-120-9 | IndicationValueUnitofMeasureText | Indication Value Unit of Measure Text |
The textual representation of the unit of measure of the indication value. |
AN | 50 | C | [ 0 .. 1 ] | [ !-~]* |
|
SIG-120-10 | IndicationValueUnitsofMeasureCodeQualifier | Indication Value Unit of Measure Code Qualifier |
Qualifier 1, 2 Qualifier to identify the code system being used. Values: See External Code List |
AN | 16 | C | [ 0 .. 1 ] | External Code List | 1|2 |
SIG-120-11 | IndicationValueUnitofMeasureCode | Indication Value Unit of Measure Code |
The code representing the unit of measure. |
AN | 15 | R | [ 1 .. 1 ] | [ !-~]* |
|
SIG-120-12 | IndicationVariableModifier | Indication 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
|
AN | 3 | C | [ 0 .. 1 ] | External Code List | AND|OR|TO |
SIG-130 | Stop | Stop Indicator |
Defines if a stop is present.
|
AN | 1 | C | [ 0 .. 1 ] | [ !-~]* |
Reference | XML Reference | IG Reference | Notes | Type | Length | Usage | Cardinality | Value Set | Validation Pattern |
---|---|---|---|---|---|---|---|---|---|
SRC-010 | Source | Source composite is represented as a "Source" XML element. |
Composite field. |
SOURCE | 38 | X | [ 0 .. 0 ] | ||
SRC-010-01 | SourceQualifier |
Qualifies the Source Description. Values: See External Code List |
AN | 2 | R | [ 1 .. 1 ] | PC|P2|PY |
||
SRC-010-02 | SourceDescription |
Name of medication history source. |
AN | 35 | O | [ 0 .. 1 ] | [ !-~]* |
||
SRC-010-03, SRC-010-04 | IDOptionalType | Composite | IDOPTIONALTYPE | 0 | X | [ 0 .. 0 ] | |||
IDValue | Reference 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. |
AN | 35 | O | [ 0 .. 1 ] | [ !-~]* |
||
IDQualifier | Reference Qualifier |
Qualifier Defines the Reference number, field 1154. X-12 DE 128. Values: See External Code List |
AN | 2 | O | [ 0 .. 1 ] | 0B|1C|1D|1E|1G|1M|1J|2U|94|ADI |
||
SRC-020 | SourceReference | Reference 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. |
AN | 35 | C | [ 0 .. 1 ] | [ !-~]* |
|
SRC-030 | FillNumber | Fill 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 |
N | 2 | C | [ 0 .. 1 ] |