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Information Technology Laboratory / Software and Systems Division

Systems Interoperability Group

RXHRES :: Release 1 :: SCRIPT

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

For more information about the NCPDP SCRIPT,

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

Overview

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

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

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

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

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

Notation

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

Usage 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

Summary

Specification Name

SCRIPT

Organization

NCPDP

SCRIPT Version

10.6

Specification Version

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

Segment

Description

Usage

Cardinality

RES

Response segment used for "NewRxRequestType" XML element

[1..1]

PVDP2

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

[0..1]

PVDPC

PVD-PC corresponding to the "Prescriber" XML element

[0..1]

PTTRXHRES

PTT segment for "Patient" XML element in RXHRES

[1..1]

COO

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

[1..1]

MedicationDispensed

[0..300]

...

Segment	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]

Message Structure Id

RXHRES

Interactions

MedicationDispensed : MedicationDispensed

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

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

Detail

MedicationDispensed

Segment/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]

RES : Response segment used for "NewRxRequestType" XML element

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

Response segment used for "NewRxRequestType" XML element Detail

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. `Repeats up to 10 times.`	AN	2	R	[ 1 .. 1 ]	External Code List	`AA\|AB\|AC\|AD\|AE\|AF\|AG\|AH\|AJ\|AK\| \|AL\|AM\|AN\|AO\|AP\|AQ`
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. `Repeats up to 10 times.`	AN	2	R	[ 1 .. 1 ]	External Code List	`AA\|AB\|AC\|AD\|AE\|AF\|AG\|AH\|AJ\|AK\| \|AL\|AM\|AN\|AO\|AP\|AQ`
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 ]		`[ !-~]*`

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

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

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

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

Reference	XML Reference	IG Reference	Notes	Type	Length	Usage	Cardinality	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 `On the mandatory transactions: One occurrence must contain the value 'D3' (NCPDP Provider ID Number). One occurrence must contain the value 'HPI' (National Provider ID`	AN	35	R	[ 1 .. 1 ]
Choice for PVD-020	FileID	Reference number and Reference Qualifier	Alphanumeric, 94 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	StateLicenseNumber	Reference number and Reference Qualifier	Alphanumeric, 0B `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	MedicareNumber	Reference number and Reference Qualifier	Alphanumeric, 1C `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	MedicaidNumber	Reference number and Reference Qualifier	Alphanumeric,1D `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	DentistLicenseNumber	Reference number and Reference Qualifier	Alphanumeric, 1E `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	UPIN	Reference number and Reference Qualifier	Alphanumeric, 1G `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	FacilityID	Reference number and Reference Qualifier	Alphanumeric, 1J `Choice` Predicate: Not applicable	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PPONumber	Reference number and Reference Qualifier	Alphanumeric, 1M `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PayerID	Reference number and Reference Qualifier	Alphanumeric, 2U `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	ProcessorIdentificationNumber	Reference number and Reference Qualifier	Alphanumeric, ADI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	BINLocationNumber	Reference number and Reference Qualifier	Alphanumeric, BO `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	Commercial	Reference number and Reference Qualifier	Alphanumeric, C1 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	MedicalRecordIdentificationNumberEHR	Reference number and Reference Qualifier	Alphanumeric, EA `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PatientAccountNumber	Reference number and Reference Qualifier	Alphanumeric, EJ `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	DEANumber	Reference number and Reference Qualifier	Alphanumeric, DH `Choice`	AN	35	R	[ 1 .. 1 ]
Choice for PVD-020	HIN	Reference number and Reference Qualifier	Alphanumeric, HI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	IndividualPolicyNumber	Reference number and Reference Qualifier	Alphanumeric, IP `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	SecondaryCoverage	Reference number and Reference Qualifier	Alphanumeric, NC `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	NAICCode	Reference number and Reference Qualifier	Alphanumeric, NF `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PromotionNumber	Reference number and Reference Qualifier	Alphanumeric, PD `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	SocialSecurity	Reference number and Reference Qualifier	Alphanumeric, SY `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	NPI	Reference number and Reference Qualifier	Alphanumeric, HPI `One occurrence must contain the value 'HPI' (National Provider ID) for mandatory occurrences of this segment. Choice` Predicate: Applicable in this case	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PriorAuthorization	Reference number and Reference Qualifier	Alphanumeric, G1 `Choice`	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. `In NEWRX this element name is "BusinessName". ERROR: In XML, the is a lack of consistency in referring to the same element in different messages.`	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\| \|FM\|FL\|GA\|GU\|HI\|ID\|IL\|IN\|IA\|KS \|KY\|LA\|ME\|MH\|MD\|MA\|MI\|MN\|MS\|MO \|MT\|NE\|NV\|NH\|NJ\|NM\|NY\|NC\|ND\|MP \|OH\|OK\|OR\|PW\|PA\|PR\|RI\|SC\|SD\|TN \|TX\|UT\|VT\|VA\|VI\|WA\|WV\|WI\|WY\|AB \|BC\|MB\|NB\|NF\|NS\|NT\|NU\|ON\|PE\|QC \|SK\|YT`
PVD-080-5	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 `BN Beeper CP Cellular EM Electronic Mail FX Fax HP Home NP Night TE Telephone WP Work`	AN	2	C	[ 0 .. 1 ]	`BN\|CP\|FX\|HP\|NP\|TE\|WP\|EM`

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

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

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

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

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) `ERROR: The XML Schema does not allow repetitions. NOTE: This element combines the reference number and qualifier but it does not exclude the identifiers types that are not applicable to prescribers.`	ID_TYPE	863	C	[ 0 .. 1 ]
Choice for PVD-020	NCPDPID	Reference number and Reference Qualifier	Alphanumeric, D3 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	FileID	Reference number and Reference Qualifier	Alphanumeric, 94 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	StateLicenseNumber	Reference number and Reference Qualifier	Alphanumeric, 0B `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	MedicareNumber	Reference number and Reference Qualifier	Alphanumeric, 1C `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	MedicaidNumber	Reference number and Reference Qualifier	Alphanumeric,1D `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	DentistLicenseNumber	Reference number and Reference Qualifier	Alphanumeric, 1E `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	UPIN	Reference number and Reference Qualifier	Alphanumeric, 1G `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	FacilityID	Reference number and Reference Qualifier	Alphanumeric, 1J `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PPONumber	Reference number and Reference Qualifier	Alphanumeric, 1M `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PayerID	Reference number and Reference Qualifier	Alphanumeric, 2U `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	ProcessorIdentificationNumber	Reference number and Reference Qualifier	Alphanumeric, ADI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	BINLocationNumber	Reference number and Reference Qualifier	Alphanumeric, BO `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	Commercial	Reference number and Reference Qualifier	Alphanumeric, C1 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	MedicalRecordIdentificationNumberEHR	Reference number and Reference Qualifier	Alphanumeric, EA `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PatientAccountNumber	Reference number and Reference Qualifier	Alphanumeric, EJ `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	DEANumber	Reference number and Reference Qualifier	Alphanumeric, DH `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	HIN	Reference number and Reference Qualifier	Alphanumeric, HI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	IndividualPolicyNumber	Reference number and Reference Qualifier	Alphanumeric, IP `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	SecondaryCoverage	Reference number and Reference Qualifier	Alphanumeric, NC `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	NAICCode	Reference number and Reference Qualifier	Alphanumeric, NF `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PromotionNumber	Reference number and Reference Qualifier	Alphanumeric, PD `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	SocialSecurity	Reference number and Reference Qualifier	Alphanumeric, SY `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	NPI	Reference number and Reference Qualifier	Alphanumeric, HPI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PriorAuthorization	Reference number and Reference Qualifier	Alphanumeric, G1 `Choice`	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. `040-I007-02-4707 is no longer supported.`	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\| \|FM\|FL\|GA\|GU\|HI\|ID\|IL\|IN\|IA\|KS \|KY\|LA\|ME\|MH\|MD\|MA\|MI\|MN\|MS\|MO \|MT\|NE\|NV\|NH\|NJ\|NM\|NY\|NC\|ND\|MP \|OH\|OK\|OR\|PW\|PA\|PR\|RI\|SC\|SD\|TN \|TX\|UT\|VT\|VA\|VI\|WA\|WV\|WI\|WY\|AB \|BC\|MB\|NB\|NF\|NS\|NT\|NU\|ON\|PE\|QC \|SK\|YT`
PVD-080-5	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 `BN Beeper CP Cellular EM Electronic Mail FX Fax HP Home NP Night TE Telephone WP Work`	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. `This field should be marked as required in the XSD because it would be required if the name appears at all. Otherwise a name may appear with empty child elements.`	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 ]		`[ !-~]*`

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

PTT for RXHRES, all elements are optional

PTT segment for "Patient" XML element in RXHRES Detail

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. `1 (Cardholder), 2 (Spouse), 3 (Child), 4 (Other).`	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. `NOTE: This element combines the reference number and qualifier but it does not exclude the identifiers types that are not applicable to prescribers.`	ID_TYPE	863	C	[ 0 .. 2 ]
Choice for PTT-050	NCPDPID	Reference number and Reference Qualifier	Alphanumeric, D3 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	FileID	Reference number and Reference Qualifier	Alphanumeric, 94 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	StateLicenseNumber	Reference number and Reference Qualifier	Alphanumeric, 0B `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	MedicareNumber	Reference number and Reference Qualifier	Alphanumeric, 1C `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	MedicaidNumber	Reference number and Reference Qualifier	Alphanumeric,1D `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	DentistLicenseNumber	Reference number and Reference Qualifier	Alphanumeric, 1E `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	UPIN	Reference number and Reference Qualifier	Alphanumeric, 1G `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	FacilityID	Reference number and Reference Qualifier	Alphanumeric, 1J `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	PPONumber	Reference number and Reference Qualifier	Alphanumeric, 1M `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	PayerID	Reference number and Reference Qualifier	Alphanumeric, 2U `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	ProcessorIdentificationNumber	Reference number and Reference Qualifier	Alphanumeric, ADI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	BINLocationNumber	Reference number and Reference Qualifier	Alphanumeric, BO `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	Commercial	Reference number and Reference Qualifier	Alphanumeric, C1 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	MedicalRecordIdentificationNumberEHR	Reference number and Reference Qualifier	Alphanumeric, EA `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	PatientAccountNumber	Reference number and Reference Qualifier	Alphanumeric number, (Qualifier= 'EJ') `This is a possible choice for patient identifier types. Choice`	AN	35	R	[ 1 .. 1 ]
Choice for PTT-050	DEANumber	Reference number and Reference Qualifier	Alphanumeric, DH `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	HIN	Reference number and Reference Qualifier	Alphanumeric, HI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	IndividualPolicyNumber	Reference number and Reference Qualifier	Alphanumeric, IP `This is a possible choice for patient identifier types. Choice`	AN	35	RE	[ 0 .. 1 ]
Choice for PTT-050	SecondaryCoverage	Reference number and Reference Qualifier	Alphanumeric, NC `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	NAICCode	Reference number and Reference Qualifier	Alphanumeric, NF `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	PromotionNumber	Reference number and Reference Qualifier	Alphanumeric, PD `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	SocialSecurity	Reference number and Reference Qualifier	Alphanumeric, SY `This is a possible choice for patient identifier types. Choice`	AN	35	RE	[ 0 .. 1 ]
Choice for PTT-050	NPI	Reference number and Reference Qualifier	Alphanumeric, HPI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PTT-050	PriorAuthorization	Reference number and Reference Qualifier	Alphanumeric, G1 `Choice`	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] ]\d)\|(3[0-1])))?$`
Choice for PTT-020	Date/Time		Date and Time	DTM	24	C	[ 0 .. 1 ]		`^\d{4}(((0[1-9])\|(1[0-2]))(((0 0[1-9])\|([1-2]\d)\|(3[0-1]))((( [01]\d\|2[0-3])([0-5]\d))(([0-5 ]\d)((\.\d{1,4}))?)?)?)?)?([+- ](([0]\d\|1[0-3])([0-5]\d)))?$`
PTT-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. `If the address of the patient is unable to be obtained, the text 'UNKNOWN' should be put in the Street Address.`	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 `If patient is homeless, the text 'HOMELESS' should be put in the Street Address.`	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\| \|FM\|FL\|GA\|GU\|HI\|ID\|IL\|IN\|IA\|KS \|KY\|LA\|ME\|MH\|MD\|MA\|MI\|MN\|MS\|MO \|MT\|NE\|NV\|NH\|NJ\|NM\|NY\|NC\|ND\|MP \|OH\|OK\|OR\|PW\|PA\|PR\|RI\|SC\|SD\|TN \|TX\|UT\|VT\|VA\|VI\|WA\|WV\|WI\|WY\|AB \|BC\|MB\|NB\|NF\|NS\|NT\|NU\|ON\|PE\|QC \|SK\|YT`
PTT-060-4	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. `BN Beeper CP Cellular EM Electronic Mail FX Fax HP Home NP Night TE Telephone WP Work`	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] ]\d)\|(3[0-1])))?$`

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

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

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

Reference	XML Reference	IG Reference	Notes	Type	Length	Usage	Cardinality	Validation Pattern
COO-010	PayerIdentification	Reference number and Reference Qualifier	Choice of relevant identifiers is not restricted to those relevant to Payer identification. Within each COO Segment, the Reference Number (010-I001) repeats >1 times. For a given Primary Payer loop of the COO Segment, the Reference Number and Qualifier are used to denote identification of the payer, for example with a BIN Number and a Processor Control Number (if applicable). The Reference Number and Reference Qualifier will loop twice if there is a BIN Number (one loop of (010-I001)) and a Processor Control Number (second loop of (010-I001)) to report. If the payer does not use a Processor Control Number, the Reference Number (010- I001) would only loop once, containing the BIN Number.	ID_TYPE	863	C	[ 0 .. 2 ]
Choice for COO-010	NCPDPID	Reference number and Reference Qualifier	Alphanumeric, D3 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	FileID	Reference number and Reference Qualifier	Alphanumeric, 94 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	StateLicenseNumber	Reference number and Reference Qualifier	Alphanumeric, 0B `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	MedicareNumber	Reference number and Reference Qualifier	Alphanumeric, 1C `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	MedicaidNumber	Reference number and Reference Qualifier	Alphanumeric,1D `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	DentistLicenseNumber	Reference number and Reference Qualifier	Alphanumeric, 1E `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	UPIN	Reference number and Reference Qualifier	Alphanumeric, 1G `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	FacilityID	Reference number and Reference Qualifier	Alphanumeric, 1J `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	PPONumber	Reference number and Reference Qualifier	Alphanumeric, 1M `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	PayerID	Reference number and Reference Qualifier	Alphanumeric, 2U `Choice`	AN	35	RE	[ 0 .. 1 ]
Choice for COO-010	ProcessorIdentificationNumber	Reference number and Reference Qualifier	Alphanumeric, ADI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	BINLocationNumber	Reference number and Reference Qualifier	Alphanumeric, BO `Choice`	AN	35	RE	[ 0 .. 1 ]
Choice for COO-010	Commercial	Reference number and Reference Qualifier	Alphanumeric, C1 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	MedicalRecordIdentificationNumberEHR	Reference number and Reference Qualifier	Alphanumeric, EA `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	PatientAccountNumber	Reference number and Reference Qualifier	Alphanumeric, EJ `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	DEANumber	Reference number and Reference Qualifier	Alphanumeric, DH `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	HIN	Reference number and Reference Qualifier	Alphanumeric, HI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	IndividualPolicyNumber	Reference number and Reference Qualifier	Alphanumeric, IP `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	SecondaryCoverage	Reference number and Reference Qualifier	Alphanumeric, NC `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	NAICCode	Reference number and Reference Qualifier	Alphanumeric, NF `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	PromotionNumber	Reference number and Reference Qualifier	Alphanumeric, PD `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	SocialSecurity	Reference number and Reference Qualifier	Alphanumeric, SY `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	NPI	Reference number and Reference Qualifier	Alphanumeric, HPI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for COO-010	PriorAuthorization	Reference number and Reference Qualifier	Alphanumeric, G1 `Choice`	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. `This element appears redundant since it is always hardcoded to "C" in this structure.`	AN	1	C	[ 0 .. 1 ]	`C`
COO-040	CardHolderID	Reference Number	Cardholder ID `"CM" field but it is not a composite. This may be a "required but may be empty in some situations" field.`	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] ]\d)\|(3[0-1])))?$`
	Date/Time		Date and Time	DTM	0	X	[ 0 .. 0 ]	`^\d{4}(((0[1-9])\|(1[0-2]))(((0 0[1-9])\|([1-2]\d)\|(3[0-1]))((( [01]\d\|2[0-3])([0-5]\d))(([0-5 ]\d)((\.\d{1,4}))?)?)?)?)?([+- ](([0]\d\|1[0-3])([0-5]\d)))?$`
Choice for COO-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] ]\d)\|(3[0-1])))?$`
	Date/Time		Date and Time	DTM	0	X	[ 0 .. 0 ]	`^\d{4}(((0[1-9])\|(1[0-2]))(((0 0[1-9])\|([1-2]\d)\|(3[0-1]))((( [01]\d\|2[0-3])([0-5]\d))(([0-5 ]\d)((\.\d{1,4}))?)?)?)?)?([+- ](([0]\d\|1[0-3])([0-5]\d)))?$`
COO-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 ]	`[ !-~]*`

DRU1 : Drug Segment for "MedicationDispensed" XML element

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

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

Drug Segment for "MedicationDispensed" XML element Detail

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. `From the SCRIPT Implementation Guide the following is stated for the Item Description: 'Is the self-contained full drug name, strength, and form.'`	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. `This element of the dataytype should be mandatory. Otherwise a XML message that contains a "DrugCoded" element that is empty would be acceptable though it does not make sense since "DrugCoded" is already optional.`	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. `The allowed qualifiers were expanded for version 10.11 to "ND\|MF\|RT\|UN\|UP"`	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. `The XSD skips elements DRU-010-10 through DRU-010-12.`	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/ `This element is used to store the DEA Schedule code: C38046 Unspecified C48672 Schedule I Substance C48675 Schedule II C48676 Schedule III C48677 Schedule IV C48679 Schedule V` Predicate: Required if the medication is categorized as a controlled substance by the Drug Enforcement Administration (DEA). The DEA Schedule would be populated by the system generating the message, and would utilize the Federal DEA Schedule classification code list, based on federal classification of the medication or the state reclassification of the medication.	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'." `This element was corrected for 10.11 and became a numeric, mandatory, maximum 11 characters in length (nM...11). Before that is was changed to (an...35) in version 4.0.`	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. `'QS' is not used in retail pharmacy NEWRX messages. If a NEWRX message is received by a retail pharmacy with the QS qualifier for a quantity of 0, then an ERROR response message must be returned. The ERROR message will contain a Status type, coded 010-9015 = '900' (Transaction Rejected). In addition, the Code List Qualifier STS-020-1131 (Reject Code) should indicate the rejection; for example, a Reject Code value of '134' to indicate 'DRU potency unit code is invalid.'`	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). `Uses NCPDP NCI subsets` Predicate: 020-I009-03-1131 value 'QS' value is used, DRU 020-I009-05-7994 Potency Unit Code must equal 'C38046' (Unspecified). DRU 020-I009-02-6060 Quantity must equal '0'.	AN	15	C	[ 0 .. 1 ]	7991	`[ !-~]*`
DRU-040	DaysSupply	Date	Note: It is strongly recommended that Days Supply (value 'ZDS' be supported. `Backwards compatibility note: The order was modified in version 10.11.`	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). `This element in the XML structure combines DRU-030-2 and 3.`	AN	140	C	[ 0 .. 1 ]		`[ !-~]*`
DRU-090	Note	Free Text	`Backwards compatibility: the order of the DRU segment was changed in 10.11 thus the later version is not backwards compatible with 10.6.`	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. R = Number of Refills 'R' implies an Original Dispensing in addition to the Quantity specified in DRU 060-I009-02- 6060. Example: If DRU 060-I009-01- 6063 = 'R' and DRU 060-I009-02-6060 = 3, the prescriber is authorizing fourdispensings. This value will appear in NEWRX messages and will not appear in REFRES messages. See Note 2. A = Additional Refills Authorized 'A' implies no Original Dispensing in addition to the quantity specified in DRU 060-I009-02-6060. Example: If DRU 060-I009-01-6063 = 'A' and DRU 060-I009-02-6060 = 3, the prescriber is authorizing three dispensings. This value will appear only in REFRES	AN	3	C	[ 0 .. 2 ]		`R\|PRN`
DRU-060-2	Refills/Value	Quantity Value	This element specifies the number of refills allowed. `Renamed "NumberOfRefills" in version 10.11 and the type was change to numeric (n..2) and used without a qualifier - it is assumed to be"R".`	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. `Qualifier - 85 is implied.`	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] ]\d)\|(3[0-1])))?$`
Choice for DRU-040-2 (85)	Date/Time		Date and Time	DTM	24	C	[ 0 .. 1 ]		`^\d{4}(((0[1-9])\|(1[0-2]))(((0 0[1-9])\|([1-2]\d)\|(3[0-1]))((( [01]\d\|2[0-3])([0-5]\d))(([0-5 ]\d)((\.\d{1,4}))?)?)?)?)?([+- ](([0]\d\|1[0-3])([0-5]\d)))?$`
DRU-040 (LD)	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. `Qualifier - LD is implied.`	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] ]\d)\|(3[0-1])))?$`
Choice for DRU-040 (LD)	Date/Time		Date and Time	DTM	24	C	[ 0 .. 1 ]		`^\d{4}(((0[1-9])\|(1[0-2]))(((0 0[1-9])\|([1-2]\d)\|(3[0-1]))((( [01]\d\|2[0-3])([0-5]\d))(([0-5 ]\d)((\.\d{1,4}))?)?)?)?)?([+- ](([0]\d\|1[0-3])([0-5]\d)))?$`
DRU-040 (36)	ExpirationDate	Date/Time/Period	`Qualifier - 36 is implied`	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] ]\d)\|(3[0-1])))?$`
Choice for DRU-040 (36)	Date/Time		Date and Time	DTM	24	C	[ 0 .. 1 ]		`^\d{4}(((0[1-9])\|(1[0-2]))(((0 0[1-9])\|([1-2]\d)\|(3[0-1]))((( [01]\d\|2[0-3])([0-5]\d))(([0-5 ]\d)((\.\d{1,4}))?)?)?)?)?([+- ](([0]\d\|1[0-3])([0-5]\d)))?$`
DRU-040 (07)	EffectiveDate	Date/Time/Period	`Qualifier - 07 is implied`	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] ]\d)\|(3[0-1])))?$`
Choice for DRU-040 (07)	Date/Time		Date and Time	DTM	24	C	[ 0 .. 1 ]		`^\d{4}(((0[1-9])\|(1[0-2]))(((0 0[1-9])\|([1-2]\d)\|(3[0-1]))((( [01]\d\|2[0-3])([0-5]\d))(([0-5 ]\d)((\.\d{1,4}))?)?)?)?)?([+- ](([0]\d\|1[0-3])([0-5]\d)))?$`
DRU-040 (PE)	PeriodEnd	Date/Time/Period	`Qualifier - PE is implied`	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] ]\d)\|(3[0-1])))?$`
Choice for DRU-040 (PE)	Date/Time		Date and Time	DTM	24	C	[ 0 .. 1 ]		`^\d{4}(((0[1-9])\|(1[0-2]))(((0 0[1-9])\|([1-2]\d)\|(3[0-1]))((( [01]\d\|2[0-3])([0-5]\d))(([0-5 ]\d)((\.\d{1,4}))?)?)?)?)?([+- ](([0]\d\|1[0-3])([0-5]\d)))?$`
DRU-040 (35)	DeliveredOnDate	Date/Time/Period	`Qualifier - 35 is implied`	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] ]\d)\|(3[0-1])))?$`
Choice for DRU-040 (35)	Date/Time		Date and Time	DTM	24	C	[ 0 .. 1 ]		`^\d{4}(((0[1-9])\|(1[0-2]))(((0 0[1-9])\|([1-2]\d)\|(3[0-1]))((( [01]\d\|2[0-3])([0-5]\d))(([0-5 ]\d)((\.\d{1,4}))?)?)?)?)?([+- ](([0]\d\|1[0-3])([0-5]\d)))?$`
DRU-040 (BE)	DateValidated	Date/Time/Period	`Qualifier - BE is implied`	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] ]\d)\|(3[0-1])))?$`
Choice for DRU-040 (BE)	Date/Time		Date and Time	DTM	24	C	[ 0 .. 1 ]		`^\d{4}(((0[1-9])\|(1[0-2]))(((0 0[1-9])\|([1-2]\d)\|(3[0-1]))((( [01]\d\|2[0-3])([0-5]\d))(([0-5 ]\d)((\.\d{1,4}))?)?)?)?)?([+- ](([0]\d\|1[0-3])([0-5]\d)))?$`
DRU-070	Diagnosis		This structure allows senders to specify two sets of primary and secondary diagnoses. `This repeated element allows for repeating groups of Primary and Secondary diagnoses.`	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 `ABF specifies ICD-10-CM DX specifies ICD-9-CM Diagnosis There is no support for SNOMED-CT.`	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 `ABF specifies ICD-10-CM DX specifies ICD-9-CM Diagnosis There is no support for SNOMED-CT and there is no support for Micromedex, Fist DataBank, or Medi-Span, unlike the Primary diagnosis.`	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\| \|2U\|BO\|DH\|HI\|NC\|NF\|PD\|SY\|HPI\|G 1\|ZZ`
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 ]		`[ !-~]*`

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

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

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

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

Reference	XML Reference	IG Reference	Notes	Type	Length	Usage	Cardinality	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). `One occurrence may be the pharmacist number. NOTE: This element combines the reference number and qualifier but it does not exclude the identifiers types that are not applicable to prescribers.`	ID_TYPE	863	R	[ 1 .. 10 ]
Choice for PVD-020	NCPDPID	Reference number and Reference Qualifier	Alphanumeric, D3 `On the mandatory transactions: One occurrence must contain the value 'D3' (NCPDP Provider ID Number). One occurrence must contain the value 'HPI' (National Provider ID`	AN	35	R	[ 1 .. 1 ]
Choice for PVD-020	FileID	Reference number and Reference Qualifier	Alphanumeric, 94 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	StateLicenseNumber	Reference number and Reference Qualifier	Alphanumeric, 0B `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	MedicareNumber	Reference number and Reference Qualifier	Alphanumeric, 1C `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	MedicaidNumber	Reference number and Reference Qualifier	Alphanumeric,1D `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	DentistLicenseNumber	Reference number and Reference Qualifier	Alphanumeric, 1E `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	UPIN	Reference number and Reference Qualifier	Alphanumeric, 1G `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	FacilityID	Reference number and Reference Qualifier	Alphanumeric, 1J `Choice` Predicate: Not applicable	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PPONumber	Reference number and Reference Qualifier	Alphanumeric, 1M `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PayerID	Reference number and Reference Qualifier	Alphanumeric, 2U `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	ProcessorIdentificationNumber	Reference number and Reference Qualifier	Alphanumeric, ADI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	BINLocationNumber	Reference number and Reference Qualifier	Alphanumeric, BO `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	Commercial	Reference number and Reference Qualifier	Alphanumeric, C1 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	MedicalRecordIdentificationNumberEHR	Reference number and Reference Qualifier	Alphanumeric, EA `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PatientAccountNumber	Reference number and Reference Qualifier	Alphanumeric, EJ `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	DEANumber	Reference number and Reference Qualifier	Alphanumeric, DH `Choice`	AN	35	R	[ 1 .. 1 ]
Choice for PVD-020	HIN	Reference number and Reference Qualifier	Alphanumeric, HI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	IndividualPolicyNumber	Reference number and Reference Qualifier	Alphanumeric, IP `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	SecondaryCoverage	Reference number and Reference Qualifier	Alphanumeric, NC `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	NAICCode	Reference number and Reference Qualifier	Alphanumeric, NF `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PromotionNumber	Reference number and Reference Qualifier	Alphanumeric, PD `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	SocialSecurity	Reference number and Reference Qualifier	Alphanumeric, SY `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	NPI	Reference number and Reference Qualifier	Alphanumeric, HPI `One occurrence must contain the value 'HPI' (National Provider ID) for mandatory occurrences of this segment. Choice` Predicate: Applicable in this case	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PriorAuthorization	Reference number and Reference Qualifier	Alphanumeric, G1 `Choice`	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. `This field in the pharmacy segment is also named "BusinessName" in NEWRX.`	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\| \|FM\|FL\|GA\|GU\|HI\|ID\|IL\|IN\|IA\|KS \|KY\|LA\|ME\|MH\|MD\|MA\|MI\|MN\|MS\|MO \|MT\|NE\|NV\|NH\|NJ\|NM\|NY\|NC\|ND\|MP \|OH\|OK\|OR\|PW\|PA\|PR\|RI\|SC\|SD\|TN \|TX\|UT\|VT\|VA\|VI\|WA\|WV\|WI\|WY\|AB \|BC\|MB\|NB\|NF\|NS\|NT\|NU\|ON\|PE\|QC \|SK\|YT`
PVD-080-5	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 `BN Beeper CP Cellular EM Electronic Mail FX Fax HP Home NP Night TE Telephone WP Work`	AN	2	C	[ 0 .. 1 ]	`BN\|CP\|FX\|HP\|NP\|TE\|WP\|EM`

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

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

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

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

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) `ERROR: The XML Schema does not allow repetitions. NOTE: This element combines the reference number and qualifier but it does not exclude the identifiers types that are not applicable to prescribers.`	ID_TYPE	863	R	[ 1 .. 10 ]
Choice for PVD-020	NCPDPID	Reference number and Reference Qualifier	Alphanumeric, D3 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	FileID	Reference number and Reference Qualifier	Alphanumeric, 94 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	StateLicenseNumber	Reference number and Reference Qualifier	Alphanumeric, 0B `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	MedicareNumber	Reference number and Reference Qualifier	Alphanumeric, 1C `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	MedicaidNumber	Reference number and Reference Qualifier	Alphanumeric,1D `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	DentistLicenseNumber	Reference number and Reference Qualifier	Alphanumeric, 1E `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	UPIN	Reference number and Reference Qualifier	Alphanumeric, 1G `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	FacilityID	Reference number and Reference Qualifier	Alphanumeric, 1J `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PPONumber	Reference number and Reference Qualifier	Alphanumeric, 1M `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PayerID	Reference number and Reference Qualifier	Alphanumeric, 2U `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	ProcessorIdentificationNumber	Reference number and Reference Qualifier	Alphanumeric, ADI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	BINLocationNumber	Reference number and Reference Qualifier	Alphanumeric, BO `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	Commercial	Reference number and Reference Qualifier	Alphanumeric, C1 `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	MedicalRecordIdentificationNumberEHR	Reference number and Reference Qualifier	Alphanumeric, EA `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PatientAccountNumber	Reference number and Reference Qualifier	Alphanumeric, EJ `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	DEANumber	Reference number and Reference Qualifier	Alphanumeric, DH `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	HIN	Reference number and Reference Qualifier	Alphanumeric, HI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	IndividualPolicyNumber	Reference number and Reference Qualifier	Alphanumeric, IP `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	SecondaryCoverage	Reference number and Reference Qualifier	Alphanumeric, NC `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	NAICCode	Reference number and Reference Qualifier	Alphanumeric, NF `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PromotionNumber	Reference number and Reference Qualifier	Alphanumeric, PD `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	SocialSecurity	Reference number and Reference Qualifier	Alphanumeric, SY `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	NPI	Reference number and Reference Qualifier	Alphanumeric, HPI `Choice`	AN	35	C	[ 0 .. 1 ]
Choice for PVD-020	PriorAuthorization	Reference number and Reference Qualifier	Alphanumeric, G1 `Choice`	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. `040-I007-02-4707 is no longer supported.`	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\| \|FM\|FL\|GA\|GU\|HI\|ID\|IL\|IN\|IA\|KS \|KY\|LA\|ME\|MH\|MD\|MA\|MI\|MN\|MS\|MO \|MT\|NE\|NV\|NH\|NJ\|NM\|NY\|NC\|ND\|MP \|OH\|OK\|OR\|PW\|PA\|PR\|RI\|SC\|SD\|TN \|TX\|UT\|VT\|VA\|VI\|WA\|WV\|WI\|WY\|AB \|BC\|MB\|NB\|NF\|NS\|NT\|NU\|ON\|PE\|QC \|SK\|YT`
PVD-080-5	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. `This field should be marked as required in the XSD because it would be required if the name appears at all. Otherwise a name may appear with empty child elements.`	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 `BN Beeper CP Cellular EM Electronic Mail FX Fax HP Home NP Night TE Telephone WP Work`	AN	2	C	[ 0 .. 1 ]	X-12 DE 365	`BN\|CP\|FX\|HP\|NP\|TE\|WP\|EM`

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

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

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

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

Reference	XML Reference	IG Reference	Notes	Type	Length	Usage	Cardinality	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\| \|DF\|DI\|DL\|DM\|DR\|DS\|ED\|ER\|EX\|HD \|IC\|ID\|LD\|LK\|LR\|MC\|MN\|MS\|MX\|NA \|NC\|ND\|NF\|NN\|NP\|NR\|NS\|OH\|PA\|PC \|PG\|PH\|PN\|PP\|PR\|PS\|RE\|RF\|SC\|SD \|SE\|SF\|SR\|SX\|TD\|TN\|TP\|UD`
DRU-100-2	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\| \|M0\|MR\|PA\|PE\|PH\|PM\|P0\|PT\|R0\|RT \|SC\|SW\|TC\|TH\|ZZ`
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\| \|1K\|2A\|2B\|3A\|3B\|3C\|3D\|3E\|3F\|3G \|3H\|3J\|3K\|3M\|3N\|4A`
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 13\|14\|15\|16\|17\|18\|19\|20\|21\|22\| 23\|24\|25\|26\|27\|28\|29\|30\|31\|32\| 33\|34\|35\|36\|37\|99`
DRU-100-6	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`

SIG : "StructuredSIG" XML element corresponds to SIG segment

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

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

"StructuredSIG" XML element corresponds to SIG segment Detail

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 `This composite in XML combines timing, frequency, and interval.`	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 `"TO" is also supported in addition to boolean operators.`	AN	3	C	[ 0 .. 1 ]	External Code List	`AND\|OR\|TO`
SIG-130	Stop	Stop Indicator	Defines if a stop is present. `Part of the STOP COMPOSITE, it corresponds to SIG-130-1.`	AN	1	C	[ 0 .. 1 ]		`[ !-~]*`

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

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

Reference	XML Reference	IG Reference	Notes	Type	Length	Usage	Cardinality	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 I\|BO\|C1\|D3\|DH\|EA\|EJ\|G1\|HI\|HPI\| IP\|NC\|NF\|PD\|SY\|ZZ`
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 ]

Health IT

Created January 10, 2017, Updated October 3, 2023