| 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 | 
 |