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 | 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 AN UNDEFINED FILE ** |
|
10 | CMOP DISPENSED | C;1 | FREE TEXT |
|
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 AN UNDEFINED FILE ** |
|
22 | PFSS CHARGE ID | PFS;2 | NUMBER |
|
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 |
|
9999999.01 | REQUESTING PROVIDER | 9999999;1 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
9999999.06 | BENCHMARK UNIT PRICE OF DRUG | 9999999;6 | NUMBER |
|
9999999.07 | REFILL BILL STATUS | 9999999;7 | SET |
|
9999999.08 | REFILL PAY STATUS | 9999999;8 | FREE TEXT |
|
9999999.09 | REFILL PAY STATUS (COMPUTED) | COMPUTED |
|
|
9999999.11 | PCC REFILL LINK | 999999911;1 | POINTER TO V MEDICATION FILE (#9000010.14) | V MEDICATION(#9000010.14)
|
9999999.12 | REFILL INSURER INFO | 9999999;12 | NUMBER |
|
9999999.13 | REFILL DUR/PPS POINTER | 9999999;13 | POINTER TO ABSP DUR/PPS FILE (#9002313.473) | ABSP DUR/PPS(#9002313.473)
|
9999999.15 | REFILL PRICING OVERRIDE | 9999999;15 | POINTER ** TO AN UNDEFINED FILE ** |
|
9999999.17 | REFILL DIAGNOSIS CODE POINTER | 9999999;17 | POINTER TO ABSP DIAGNOSIS CODE FILE (#9002313.491) | ABSP DIAGNOSIS CODE(#9002313.491)
|
9999999.18 | PRIORITY | 9999999;18 | SET |
|
9999999.19 | RXNORM CODE | 9999999;19 | FREE TEXT |
|