Parent File | Name | Number | Package |
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ERX HOLDING QUEUE(#52.49) | 2017 MEDICATIONS | 52.49311 | Outpatient Pharmacy |
Field # | Name | Loc | Type | Details |
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.01 | SEQUENCE | 0;1 | NUMBER |
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.02 | TYPE | 0;2 | SET |
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.03 | DRUG DESCRIPTION | 0;3 | FREE TEXT |
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1.1 | DC PRODUCT CODE | 1;1 | FREE TEXT |
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1.2 | DC PRODUCT CODE QUALIFIER | 1;2 | POINTER TO ERX SERVICE REASON CODES FILE (#52.45) | ERX SERVICE REASON CODES(#52.45)
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1.3 | DC STRENGTH VALUE | 1;3 | FREE TEXT |
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1.4 | DC STRENGTH FORM | 1;4 | POINTER TO ERX SERVICE REASON CODES FILE (#52.45) | ERX SERVICE REASON CODES(#52.45)
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1.5 | DC STRENGTH UNIT OF MEASURE | 1;5 | POINTER TO ERX SERVICE REASON CODES FILE (#52.45) | ERX SERVICE REASON CODES(#52.45)
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1.6 | DC DRUG DB CODE | 1;6 | FREE TEXT |
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1.7 | DC DRUG DB QUALIFIER | 1;7 | POINTER TO ERX SERVICE REASON CODES FILE (#52.45) | ERX SERVICE REASON CODES(#52.45)
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1.8 | DC DEA SCHEDULE CODE | 1;8 | POINTER TO ERX SERVICE REASON CODES FILE (#52.45) | ERX SERVICE REASON CODES(#52.45)
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2.1 | QUANTITY VALUE | 2;1 | NUMBER |
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2.2 | QUANTITY CODE LIST QUALIFIER | 2;2 | POINTER TO ERX SERVICE REASON CODES FILE (#52.45) | ERX SERVICE REASON CODES(#52.45)
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2.3 | QUANTITY UNIT OF MEASURE | 2;3 | POINTER TO ERX SERVICE REASON CODES FILE (#52.45) | ERX SERVICE REASON CODES(#52.45)
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2.4 | DAYS SUPPLY | 2;4 | NUMBER |
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2.5 | WRITTEN DATE | 2;5 | DATE |
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2.6 | LAST FILL DATE | 2;6 | DATE |
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2.7 | SUBSTITUTIONS | 2;7 | SET |
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2.8 | NUMBER OF REFILLS | 2;8 | NUMBER |
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3 | 2017 DIAGNOSIS | 3;0 | Multiple #52.493113 | 52.493113
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4.1 | PRIOR AUTHORIZATION | 4;1 | FREE TEXT |
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4.2 | PRIOR AUTHORIZATION STATUS | 4;2 | SET |
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4.3 | PHARMACY REQUESTED REFILLS | 4;3 | NUMBER |
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4.4 | REASON FOR SUBSTITUTION CODE | 4;4 | FREE TEXT |
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5 | NOTE | 5;1 | FREE TEXT |
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6 | DRUG USE EVALUATION | 6;0 | Multiple #52.493116 | 52.493116
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7 | DRUG COVERAGE STATUS | 7;0 | Multiple #52.493117 | 52.493117
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8 | SIG TEXT | 8;0 | WORD-PROCESSING #52.493118 |
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9.1 | SNOMED VERSION | 9;1 | FREE TEXT |
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9.2 | FMT VERSION | 9;2 | FREE TEXT |
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12 | INSTRUCTIONS | 12;0 | Multiple #52.4931112 | 52.4931112
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13 | INDICATION FOR USE | 13;0 | Multiple #52.4931113 | 52.4931113
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14 | MAXIMUM DOSE RESTRICTION | 14;0 | Multiple #52.4931114 | 52.4931114
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15 | SIG CLARIFYING FREE TEXT | 15;1 | FREE TEXT |
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16.1 | DO NOT FILL | 16;1 | SET |
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16.2 | TIME ZONE IDENTIFIER | 16;2 | SET |
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16.3 | TIME ZONE DIFF QTY | 16;3 | FREE TEXT |
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16.4 | ORDER CAPTURE METHOD | 16;4 | SET |
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16.5 | REASON FOR SUBSTITUTIONS | 16;5 | SET |
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16.6 | SPLIT SCRIPT | 16;6 | SET |
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16.7 | RX FILL INDICATOR | 16;7 | FREE TEXT |
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17 | OFFICE OF PHARMACY AFFAIRS | 17;0 | Multiple #52.4931117 | 52.4931117
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18.1 | DELIVERY REQUEST | 18;1 | SET |
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18.2 | DELIVERY LOCATION | 18;2 | SET |
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19.1 | DIAB SPLY TEST FREQ | 19;1 | NUMBER |
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19.2 | DIAB SPLY INDICATOR | 19;2 | SET |
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19.3 | DIAB INSULIN DEPENDENT | 19;3 | SET |
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19.4 | DIAB HAS AUTO DEVICE | 19;4 | SET |
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19.5 | DIAB SPLY FREQ NOTES | 19;5 | FREE TEXT |
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20.1 | INJURY RELATED | 20;1 | SET |
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21.1 | AGNCY OF SVC BUSINESS NAME | 21;1 | FREE TEXT |
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21.2 | AGNCY OF SVC ADDRESS LINE 1 | 21;2 | FREE TEXT |
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21.3 | AGNCY OF SVC ADDRESS LINE 2 | 21;3 | FREE TEXT |
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21.4 | AGNCY OF SVC CITY | 21;4 | FREE TEXT |
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21.5 | AGNCY OF SVC STATE/PROVINCE | 21;5 | FREE TEXT |
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21.6 | AGNCY OF SVC POSTAL CODE | 21;6 | FREE TEXT |
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21.7 | AGNCY OF SVC COUNTRY CODE | 21;7 | FREE TEXT |
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25 | 2017 AGNCY OF SVC COMM | 25;0 | Multiple #52.4931125 | 52.4931125
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26 | 2017 AGNCY OF SVC DIR ADD | 26;1 | FREE TEXT |
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27.1 | AGNCY CONTACT LAST NAME | 27;1 | FREE TEXT |
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27.2 | AGNCY CONTACT FIRST NAME | 27;2 | FREE TEXT |
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27.3 | AGNCY CONTACT MIDDLE NAME | 27;3 | FREE TEXT |
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27.4 | AGNCY CONTACT SUFFIX | 27;4 | FREE TEXT |
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27.5 | AGNCY CONTACT PREFIX | 27;5 | FREE TEXT |
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28 | IV ADMIN # OF LUMENS | 28;1 | FREE TEXT |
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29.1 | IV ADMIN DILUENT QTY | 29;1 | NUMBER |
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29.2 | IV ADMIN DILUENT QUALIFIER | 29;2 | POINTER TO ERX SERVICE REASON CODES FILE (#52.45) | ERX SERVICE REASON CODES(#52.45)
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29.3 | IV ADMIN DILUENT QUOM | 29;3 | POINTER TO ERX SERVICE REASON CODES FILE (#52.45) | ERX SERVICE REASON CODES(#52.45)
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30 | IV SPEC ADMIN GAUGE | 30;1 | NUMBER |
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31 | IV SPEC ADMIN BRAND | 31;1 | FREE TEXT |
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32 | IV SPEC ADMIN LENGTH | 32;1 | FREE TEXT |
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33.1 | IV SPEC ADMIN PUMP | 33;1 | SET |
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34.1 | IVA TYPE CODE | 34;1 | FREE TEXT |
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35 | IVA TYPE TEXT | 35;1 | FREE TEXT |
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36 | IVA DEVICE DESCRIPTION | 36;1 | FREE TEXT |
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37.1 | IVA DEVICE TYPE CODE | 37;1 | FREE TEXT |
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38 | IVA DEVICE TYPE TEXT | 38;1 | FREE TEXT |
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39.1 | IVA CATHETER TIP CODE | 39;1 | FREE TEXT |
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40 | IVA CATHETER TIP TEXT | 40;1 | FREE TEXT |
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41 | IVA CATHETER TIP DESC | 41;1 | FREE TEXT |
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42.1 | IV INFUSION CODE | 42;1 | FREE TEXT |
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43 | IV INFUSION TEXT | 43;1 | FREE TEXT |
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44 | IV INFUSION DESCRIPTION | 44;1 | FREE TEXT |
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45.1 | TREATMENT INDICATOR | 45;1 | SET |
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45.2 | PROPHYLACTIC OR EPISODIC | 45;2 | SET |
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45.3 | CURRENT TREATMENT CYCLE | 45;3 | NUMBER |
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45.4 | NUMBER OF CYCLES PLANNED | 45;4 | NUMBER |
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46 | WOUND | 46;0 | Multiple #52.4931146 | 52.4931146
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47 | PRESCRIBER CHECKED REMS | 47;1 | SET |
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48.1 | REMS PATIENT RISK CATEGORY | 48;1 | FREE TEXT |
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48.2 | REMS AUTHORIZATION | 48;2 | FREE TEXT |
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49.1 | PHARMACY TO TITRATE DOSE | 49;1 | SET |
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51 | TITRATION DOSE MEASUREMENT | 51;0 | Multiple #52.4931151 | 52.4931151
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55.1 | FLAVORING REQUESTED | 55;1 | SET |
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56.1 | COMPOUND PHARM DOSAGE FORM | 56;1 | FREE TEXT |
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57 | COMPOUND ING LOT NOT USED | 57;0 | Multiple #52.4931157 | 52.4931157
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58.1 | # OF PACKAGES TO BE DISPENSED | 58;1 | NUMBER |
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59 | PATIENT CODIFIED NOTES | 59;0 | Multiple #52.4931159 | 52.4931159
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61 | FACILITY SPEC ADMIN TIMING | 61;0 | Multiple #52.4931161 | 52.4931161
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62 | OTHER MEDICATION DATE | 62;0 | Multiple #52.4931162 | 52.4931162
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63.1 | NEED NO LATER THAN DT | 63;1 | FREE TEXT |
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63.2 | NEED NO LATER THAN REASON | 63;2 | FREE TEXT |
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63.3 | PSO NON SELF ADMIN PRODUCT | 63;3 | NUMBER |
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63.4 | PROVIDER EXP AUTH TO ADMIN | 63;4 | SET |
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64 | TYPE OF SVC FREE TEXT | 64;1 | FREE TEXT |
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65 | TYPE OF SVC TEXT | 65;1 | FREE TEXT |
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66 | TYPE OF SVC QUALIFIER | 66;1 | FREE TEXT |
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67 | TYPE OF SVC CODE | 67;1 | FREE TEXT |
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68 | TARGETED SERVICE FREE TEXT | 68;1 | FREE TEXT |
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69 | TARGETED SERVICE TEXT | 69;1 | FREE TEXT |
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71 | TARGETED SERVICE QUALIFIER | 71;1 | FREE TEXT |
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72 | TARGETED SERVICE CODE | 72;1 | FREE TEXT |
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73 | REASON FOR MTM FREE TEXT | 73;1 | FREE TEXT |
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74 | REASON FOR MTM TEXT | 74;1 | FREE TEXT |
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75 | REASON FOR MTM QUALIFIER | 75;1 | FREE TEXT |
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76 | REASON FOR MTM CODE | 76;1 | FREE TEXT |
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77 | TYPE OF SVC EXP DATE | 77;1 | DATE |
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78 | TYPE OF SVC EFF DATE | 78;1 | DATE |
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79 | TYPE OF SVC GROUP SETTING | 79;1 | FREE TEXT |
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81 | FINAL COMP PHARM DOSAGE FORM | 81;1 | POINTER TO ERX SERVICE REASON CODES FILE (#52.45) | ERX SERVICE REASON CODES(#52.45)
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