TH01 Version/Release Number Code uniquely identifying the transaction. Format = xx.x R TH02 Transaction Control Number Sender assigned code uniquely identifying a transaction. R TH03 Transaction Type Identifies the purpose of initiating the transaction. 01 Send/Request Transaction 02 Acknowledgement (used in Response only) 03 Error Receiving (used in Response only) 04 Void (used to void a specific Rx in a real-time transmission or an entire batch that has been transmitted) RR TH04 Response ID Contains the Transaction Control Number of a transaction that initiated the transaction. Required in response transaction only. N TH05 Creation Date Date the transaction was created. Format: CCYYMMDD. R TH06 Creation Time Time the transaction was created. Format: HHMMSS or HHMM. R TH07 File Type P = Production T = Test R TH08 Routing Number Reserved for real-time transmissions that go through a network switch to indicate, if necessary, the specific state PMP the transaction should be routed to. N TH09 Segment Terminator Character This terminates the TH segment and sets the actual value of the data segment terminator for the entire transaction. R IS: Information Source Required segment; used to convey the name and identification numbers of the entity supplying the information. IS01 Unique Information Source ID Reference number or identification number. (Example: phone number) R IS02 Information Source Entity Name Entity name of the Information Source. R IS03 Message Free-form text message. N
PAT10 Name Prefix Patient’s name prefix such as Mr. or Dr. RR (if available) PAT11 Name Suffix Patient’s name suffix such as Jr. or the III. RR (if available) PAT12 Address Information – 1 Free-form text for street address information. R PAT13 Address Information – 2 Free-form text for additional address information. RR (if available) PAT14 City Address Free-form text for city name. R PAT15 State Address U.S. Postal Service state code Note: Field has been sized to handle international patients not residing in the RR PAT16 ZIP Code Address U.S. Postal Service ZIP code. Populate with zeros if patient address is outside the R PAT17 Phone Number Complete phone number including area code. N PAT18 Date of Birth Date patient was born. Format: CCYYMMDD R PAT19 Gender Code Code indicating the sex of the patient. F Female M Male U Unknown RR PAT20 Species Code Used if required by the PMP to differentiate a prescription for an individual from one prescribed for an animal. 01 Human 02 Veterinary Patient RR
DSP21 Electronic Prescription Order Number Note: DSP20 and DSP21 should be reported as a pair to the prescription drug monitoring program, and each program decides which one, if not both, it decides to capture. N PRE: Prescriber Information Required segment; used to identify the prescriber of the prescription. PRE01 National Provider Identifier (NPI) Identifier assigned to the prescriber by CMS. RR (if available) PRE02 DEA Number Identifying number assigned to a prescriber or an institution by the Drug Enforcement Administration (DEA). R PRE03 DEA Number Suffix Identifying number assigned to a prescriber by an institution when the institution’s number is used as the DEA number. RR (if available) PRE04 License Number Identification assigned to the prescriber by the State Licensing Board. N PRE05 Last Name Prescriber’s last name. RR PRE06 First Name Prescriber’s first name. RR PRE07 Middle Name Prescriber’s middle name or initial. N PRE08 Phone Number N CDI: Compound Drug Ingredient Detail Use of this segment is situational; required when medication dispensed is a compound and one of the ingredients is a PMP reporting drug. If more than one ingredient is for a prescription monitoring program reporting drug, then this would be incremented by one for each compound ingredient being reported. CDI01 Compound Drug Ingredient Sequence Number First reportable ingredient is 1; each additional reportable ingredient is incremented by 1. R CDI02 Product ID Qualifier Code to identify the type of product ID contained in CDI03. 01 NDC 02 UPC 03 HRI 04 UPN 05 DIN 06 Compound (this code is not used in this segment) R CDI03 Product ID Full product identification as indicated in CDI02, including leading zeros without punctuation. R