| Parent File | Name | Number | Package | 
|---|---|---|---|
| PRESCRIPTION(#52) | REFILL | 52.1 | Outpatient Pharmacy | 
| Field # | Name | Loc | Type | Details | 
|---|---|---|---|---|
| .01 | REFILL DATE | 0;1 | DATE | 
  | 
| 1 | QTY | 0;4 | NUMBER | ************************REQUIRED FIELD************************ 
  | 
| 1.1 | DAYS SUPPLY | 0;10 | NUMBER | ************************REQUIRED FIELD************************ 
  | 
| 1.2 | CURRENT UNIT PRICE OF DRUG | 0;11 | NUMBER | 
  | 
| 2 | MAIL/WINDOW/PARK | 0;2 | SET | ************************REQUIRED FIELD************************ 
 
  | 
| 3 | REMARKS | 0;3 | FREE TEXT | 
  | 
| 4 | PHARMACIST NAME | 0;5 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
  | 
| 5 | LOT # | 0;6 | FREE TEXT | 
  | 
| 6 | CLERK CODE | 0;7 | POINTER TO NEW PERSON FILE (#200) | ************************REQUIRED FIELD************************ NEW PERSON(#200)
  | 
| 7 | LOGIN DATE | 0;8 | DATE | 
  | 
| 8 | DIVISION | 0;9 | POINTER TO OUTPATIENT SITE FILE (#59) | ************************REQUIRED FIELD************************ OUTPATIENT SITE(#59)
  | 
| 9 | IB NUMBER | IB;1 | POINTER TO INTEGRATED BILLING ACTION FILE (#350) | INTEGRATED BILLING ACTION(#350)
  | 
| 9.1 | COPAY EXCEEDING CAP | IB;2 | POINTER TO IB COPAY TRANSACTIONS FILE (#354.71) | IB COPAY TRANSACTIONS(#354.71)
  | 
| 10.1 | DISPENSED DATE | 0;19 | DATE | ************************REQUIRED FIELD************************ 
  | 
| 11 | NDC | 1;3 | FREE TEXT | 
  | 
| 12 | MANUFACTURER | 0;14 | FREE TEXT | 
  | 
| 13 | DRUG EXPIRATION DATE | 0;15 | DATE | 
  | 
| 14 | RETURNED TO STOCK | 0;16 | DATE | 
  | 
| 15 | PROVIDER | 0;17 | POINTER TO NEW PERSON FILE (#200) | ************************REQUIRED FIELD************************ NEW PERSON(#200)
  | 
| 16 | GENERIC PROVIDER | 1;1 | FREE TEXT | 
  | 
| 17 | RELEASED DATE/TIME | 0;18 | DATE | 
  | 
| 18 | BINGO WAIT TIME | 1;2 | NUMBER | 
  | 
| 19 | FILLING PERSON | 1;4 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
  | 
| 20 | CHECKING PHARMACIST | 1;5 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
  | 
| 21 | PFSS ACCOUNT REFERENCE | PFS;1 | POINTER TO PFSS ACCOUNT FILE (#375) | PFSS ACCOUNT(#375)
  | 
| 22 | PFSS CHARGE ID | PFS;2 | NUMBER | 
  | 
| 23 | ADMINISTERED IN CLINIC | 0;20 | SET | 
 
  | 
| 24 | ACTIVE DUTY OVERRIDE | 1;6 | SET | 
 
  | 
| 81 | DAW CODE | EPH;1 | FREE TEXT | 
  | 
| 82 | RE-TRANSMIT FLAG | EPH;2 | SET | 
 
  | 
| 83 | DATE NDC VALIDATED | EPH;3 | DATE | 
  | 
| 84 | NDC VALIDATED BY | EPH;4 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
  | 
| 85 | BILLING ELIGIBILITY INDICATOR | EPH;5 | SET | 
 
  | 
| 86 | EPHARMACY SUSPENSE HOLD DATE | EPH;6 | DATE | 
  | 
| 91 | REMOTE FILL SITE | RF;1 | FREE TEXT | 
  | 
| 92 | REMOTE PHARMACIST | RF;2 | FREE TEXT | 
  | 
| 93 | REMOTE PHARMACIST PHONE | RF;3 | FREE TEXT | 
  | 
| 94 | REFILL SOURCE | RF1;1 | FREE TEXT | 
  | 
| 95 | PERSON REQUESTING REFILL | RF1;2 | FREE TEXT | 
  | 
| 96 | REMOTE FILLING PERSON | RF;6 | FREE TEXT | 
  | 
| 97 | REMOTE CHECKING PHARMACIST | RF;5 | FREE TEXT | 
  | 
| 98 | BYPASS 3/4 DAY SUPPLY LOGIC | 1;7 | SET (BOOLEAN Data Type) | 
 
  |