GLOBAL MAP DATA DICTIONARY #52.49 -- ERX HOLDING QUEUE FILE 3/24/25 PAGE 1
STORED IN ^PS(52.49, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 7.0)
-----------------------------------------------------------------------------------------------------------------------------------
This file holds the eRx prescriptions received from Change Healthcare.
CROSS
REFERENCED BY: ERX HUB ID(B), ERX ORDER STATUS(C), VISTA PATIENT(D), OE/RR ORDER NUMBER(ORN), RELATES TO HUB ID(RTHID)
INDEXED BY: PHARMACY PRESCRIPTION NUMBER (ADRGVRX), MESSAGE DATE/TIME & ERX ORDER STATUS (AMSGDTSTS), EXTERNAL PATIENT
IDENTIFIER & VISTA PATIENT & PATIENT VALIDATED DATE/TIME (APATVPAT), EXTERNAL PROVIDER & VA MATCHED PROVIDER &
PROVIDER VALIDATED DATE/TIME (APRVVPRV), VISTA PATIENT & EXTERNAL PATIENT IDENTIFIER & MESSAGE DATE/TIME (AVPAT), VA
MATCHED PROVIDER & EXTERNAL PROVIDER & MESSAGE DATE/TIME (AVPRV), CH MESSAGE ID (CHVID), RELATED INSTITUTION & ERX
ORDER STATUS & MESSAGE DATE/TIME (E), RELATED INSTITUTION & MESSAGE DATE/TIME & EXTERNAL PATIENT IDENTIFIER (EPAT),
RELATED INSTITUTION & MESSAGE DATE/TIME & EXTERNAL PROVIDER (EPROV), RELATED INSTITUTION & MESSAGE DATE/TIME & ERX
ORDER STATUS (F), ERX HUB ID (FMID), RELATED INSTITUTION & MESSAGE DATE/TIME & MESSAGE TYPE (MTYPE), RELATED
INSTITUTION & ERX ORDER STATUS & EXTERNAL PATIENT IDENTIFIER & MESSAGE DATE/TIME (PAT), EXTERNAL PATIENT IDENTIFIER
& MESSAGE DATE/TIME (PAT2), RELATED OR PARENT MESSAGE ID (RTMID)
^PS(52.49,D0,0)= (#.01) ERX HUB ID [1N] ^ (#.02) RELATED OR PARENT MESSAGE ID [2F] ^ (#.03) MESSAGE DATE/TIME [3D] ^ (#.04)
==>EXTERNAL PATIENT IDENTIFIER [4P:52.46] ^ (#.05) VISTA PATIENT [5P:2] ^ (#.06) INSTITUTION [6P:4] ^ (#.07)
==>PHARMACY SYSTEM [7P:59.7] ^ (#.08) MESSAGE TYPE [8S] ^ (#.09) EXTERNAL/PROVIDER ORDER NUMBER [9F] ^ (#.1) VISTA
==>PENDING OUTPATIENT ORDER [10N] ^ (#.12) OE/RR ORDER NUMBER [11P:100] ^ (#.13) PHARMACY PRESCRIPTION NUMBER
==>[12P:52] ^ ^ (#.14) RELATES TO HUB ID [14F] ^
^PS(52.49,D0,1)= (#1) ERX ORDER STATUS [1P:52.45] ^ (#1.2) PROV STAT (AUTO MATCHING) [2S] ^ (#1.3) PROV STAT (MANUAL VALIDATION)
==>[3S] ^ (#1.4) DRUG STAT (AUTO MATCHING) [4S] ^ (#1.5) DRUG STAT (MANUAL VALIDATION) [5S] ^ (#1.6) PATIENT STATUS
==>(AUTO MATCHING) [6S] ^ (#1.7) PATIENT STATUS (MANUAL VAL) [7S] ^ (#1.8) PROVIDER VALIDATED BY [8P:200] ^ (#1.9)
==>PROVIDER VALIDATED DATE/TIME [9D] ^ ^ (#1.11) DRUG VALIDATED BY [11P:200] ^ (#1.12) DRUG VALIDATED DATE/TIME
==>[12D] ^ (#1.13) PATIENT VALIDATED BY [13P:200] ^ (#1.14) PATIENT VALIDATED DATE/TIME [14D] ^
^PS(52.49,D0,2)= (#2.1) EXTERNAL PROVIDER [1P:52.48] ^ (#2.2) EXTERNAL PHARMACIST [2P:52.48] ^ (#2.3) VA MATCHED PROVIDER
==>[3P:200] ^ (#2.4) TO/FROM QUALIFIER [4S] ^ (#2.5) ERX EXTERNAL PHARMACY [5P:52.47] ^ (#2.6) ERX EXTERNAL
==>SUPERVISOR [6P:52.48] ^ (#2.7) PROVIDER AUTO VALIDATED FLAG [7S] ^
^PS(52.49,D0,3)= (#3.1) EXTERNAL DRUG/SUPPLY [1F] ^ (#3.2) MATCHED DRUG/SUPPLY [2P:50] ^
^PS(52.49,D0,4)= (#4.1) PRODUCT CODE [1F] ^ (#4.2) PRODUCT CODE QUALIFIER [2S] ^ (#4.3) STRENGTH [3F] ^ (#4.4) DRUG DB CODE [4F]
==>^ (#4.5) FORM SOURCE CODE [5S] ^ (#4.6) FORM CODE [6F] ^ (#4.7) STRENGTH SOURCE CODE [7S] ^ (#4.8) STRENGTH CODE
==>[8F] ^ (#4.9) DEA SCHEDULE [9F] ^ (#4.11) DRUG DB CODE QUALIFIER [10P:52.45] ^
^PS(52.49,D0,5)= (#5.1) QUANTITY [1N] ^ (#5.2) CODE LIST QUALIFIER [2S] ^ (#5.3) UNIT SOURCE CODE [3S] ^ (#5.4) POTENCY UNIT CODE
==>[4F] ^ (#5.5) DAYS SUPPLY [5N] ^ (#5.6) REFILLS [6N] ^ (#5.7) REFILL QUALIFIER [7S] ^ (#5.8) SUBSTITUTIONS [8S]
==>^ (#5.9) WRITTEN DATE [9D] ^
^PS(52.49,D0,6)= (#6.1) LAST FILL DATE [1D] ^ (#6.2) EXPIRATION DATE [2D] ^ (#6.3) EFFECTIVE DATE [3D] ^ (#6.4) PERIOD END [4D] ^
==>(#6.5) DELIVERED ON DATE [5D] ^ (#6.6) DATE VALIDATED [6D] ^ (#6.7) FUTURE FILL HOLD DATE [7D] ^
^PS(52.49,D0,7)= (#7) DIRECTIONS [1F] ^
^PS(52.49,D0,8)= (#8) NOTES [1F] ^
^PS(52.49,D0,9,0)=^52.499^^ (#9) DIAGNOSIS
^PS(52.49,D0,9,D1,0)= (#.01) SEQUENCE [1N] ^ (#.02) CLINICAL INFORMATION QUALIFIER [2S] ^ (#.03) PRIMARY DX QUALIFIER [3S] ^
==>(#.04) PRIMARY DX VALUE [4F] ^ (#.05) SECONDARY DX QUALIFIER [5S] ^ (#.06) SECONDARY DX VALUE [6F] ^
^PS(52.49,D0,10)= ^ (#10.2) PRIOR AUTHORIZATION [2F] ^ (#10.3) PRIOR AUTHORIZATION QUALIFIER [3P:52.45] ^ (#10.4) PRIOR
==>AUTHORIZATION STATUS [4S] ^ (#10.5) DO NOT FILL [5S] ^ (#10.6) NEEDED NO LATER THAN [6D] ^ (#10.7) TIMEZONE
==>[7F] ^ (#10.8) TIME ZONE DIFFERENCE QUANTITY [8F] ^ (#10.9) NEEDED NO LATER THAN REASON [9F] ^
^PS(52.49,D0,11,0)=^52.4911A^^ (#11) STRUCTURED SIG
^PS(52.49,D0,11,D1,0)= (#.01) SIG SEQUENCE POSITION NUMBER [1N] ^ (#.02) MULTIPLE SIG MODIFIER [2S] ^ (#.03) SNOMED VERSION [3F]
==>^ (#.04) FMT VERSION [4F] ^ (#.05) FREE TEXT STRING INDICATOR [5F] ^
^PS(52.49,D0,11,D1,1)= (#1) SIG FREE TEXT [1F] ^
^PS(52.49,D0,11,D1,2)= (#2.1) DOSE COMPOSITE INDICATOR [1N] ^ (#2.2) DD METHOD TEXT [2F] ^ (#2.3) DD METHOD CODE QUALIFIER [3S] ^
==>(#2.4) DOSE DELIVERY METHOD CODE [4F] ^ (#2.5) DD METHOD MODIFIER TEXT [5F] ^ (#2.6) DD METHOD MOD CODE
==>[6F] ^ (#2.7) DD METHOD MOD CODE QUAL [7S] ^
^PS(52.49,D0,11,D1,3)= (#3.1) DOSE QUANTITY [1N] ^ (#3.2) DOSE FORM TEXT [2F] ^ (#3.3) DOSE FORM CODE [3F] ^ (#3.4) DOSE FORM
==>CODE QUALIFIER [4S] ^ (#3.5) DOSE RANGE MODIFIER [5S] ^
^PS(52.49,D0,11,D1,4)= (#4.1) DC BASIS NUMERIC VALUE [1N] ^ (#4.2) DC DOSING UM TEXT [2F] ^ (#4.3) DC DOSING UM CODE [3F] ^
==>(#4.4) DC DOSING UM CODE MODIFIER [4S] ^ (#4.5) DC BODY METRIC QUALIFIER [5S] ^ (#4.6) DC BODY METRIC
==>VALUE [6N] ^ (#4.7) DC CALC DOSE NUMERIC [7N] ^ (#4.8) DC CALC DOSE UM TEXT [8F] ^ (#4.9) DC CALC DOSE UM
==>CODE [9F] ^ (#4.11) DC CALC DOSE UM CODE QUALIFIER [10S] ^ (#4.12) DC CALC DOSING BASIS RANGE MOD [11S] ^
^PS(52.49,D0,11,D1,5)= (#5.1) VEHICLE NAME [1F] ^ (#5.2) VEHICLE NAME CODE [2F] ^ (#5.3) VEHICLE NAME CODE QUALIFIER [3S] ^
==>(#5.4) VEHICLE QUANTITY [4N] ^ (#5.5) VEHICLE UNIT OF MEASURE TEXT [5F] ^ (#5.6) VEHICLE UNIT OF MEASURE
==>CODE [6F] ^ (#5.7) VEHICLE UM CODE QUALIFIER [7S] ^ (#5.8) MULTIPLE VEHICLE MODIFIER [8S] ^
^PS(52.49,D0,11,D1,6)= (#6.1) ROUTE ADMIN TEXT [1F] ^ (#6.2) ROUTE ADMIN CODE [2F] ^ (#6.3) ROUTE ADMIN CODE QUALIFIER [3S] ^
==>(#6.4) MULT ROUTE ADMIN MODIFIER [4S] ^ (#6.5) SITE ADMIN TEXT [5F] ^ (#6.6) SITE ADMIN CODE [6F] ^ (#6.7)
==>SITE ADMIN CODE QUALIFIER [7S] ^ (#6.8) MULT ADMIN TIMING MODIFIER [8S] ^
^PS(52.49,D0,11,D1,7)= (#7.1) ADMIN TIMING TEXT [1F] ^ (#7.2) ADMIN TIMING CODE [2F] ^ (#7.3) ADMIN TIMING CODE QUALIFIER [3S] ^
==>(#7.4) MULTIPLE ADMIN TIMING MODIFIER [4S] ^ (#7.5) RATE OF ADMINISTRATION [5F] ^ (#7.6) RATE UNIT MEASURE
==>TEXT [6F] ^ (#7.7) RATE UNIT MEASURE CODE [7F] ^ (#7.8) RATE UNIT OF MEASURE CODE QUAL [8S] ^
^PS(52.49,D0,11,D1,8)= (#8.1) TP BASIS TEXT [1F] ^ (#8.2) TP BASIS CODE [2F] ^ (#8.3) TB BASIS CODE QUALIFIER [3S] ^ (#8.4) FREQ
==>NUMERIC VALUE [4F] ^ (#8.5) FREQ UNITS TEXT [5F] ^ (#8.6) FREQ UNITS CODE [6F] ^ (#8.7) FREQ UNITS CODE
==>QUALIFIER [7S] ^ (#8.8) VARIABLE FREQ MODIFIER [8S] ^
^PS(52.49,D0,11,D1,9)= (#9.1) INTERVAL NUMERIC VALUE [1F] ^ (#9.2) INTERVAL UNITS TEXT [2F] ^ (#9.3) INTERVAL UNITS CODE [3F] ^
==>(#9.4) INTERVAL UNITS CODE QUAL [4S] ^ (#9.5) VARIABLE INTERVAL MODIFIER [5S] ^ (#9.6) DUR NUMERIC VALUE
==>[6F] ^ (#9.7) DUR TEXT [7F] ^ (#9.8) DUR TEXT CODE [8F] ^ (#9.9) DUR TEXT CODE QUALIFIER [9S] ^
^PS(52.49,D0,11,D1,10)= (#10.1) MDR NUMERIC VALUE [1N] ^ (#10.2) MDR UNITS TEXT [2F] ^ (#10.3) MDR CODE QUALIFIER [3S] ^ (#10.4)
==>MDR UNITS CODE [4F] ^ (#10.5) MDR VAR NUMERIC VALUE [5N] ^ (#10.6) MDR VAR UNITS TEXT [6F] ^ (#10.7) MDR
==>VARIABLE UNITS CODE [7F] ^ (#10.8) MDR VAR UNITS CODE QUALIFIER [8S] ^ (#10.9) MDR VAR DURATION MODIFIER
==>[9S] ^
^PS(52.49,D0,11,D1,11)= (#11.1) IP TEXT [1F] ^ (#11.2) IP CODE [2F] ^ (#11.3) IP CODE QUALIFIER [3S] ^ (#11.4) INDICATION TEXT
==>[4F] ^ (#11.5) INDICATION TEXT CODE [5F] ^ (#11.6) INDICATION TEXT CODE QUALIFIER [6S] ^
^PS(52.49,D0,11,D1,12)= (#12.1) INDICATION VALUE TEXT [1F] ^ (#12.2) INDICATION VALUE UNIT [2N] ^ (#12.3) IV UNIT OF MEASURE TEXT
==>[3F] ^ (#12.4) IV UNIT OF MEAURE CODE [4F] ^ (#12.5) IV UNIT OF MEASURE CODE QUAL [5S] ^ (#12.6)
==>INDICATION VARIABLE MODIFIER [6S] ^ (#12.7) STOP INDICATOR [7S] ^
^PS(52.49,D0,12,0)=^52.4912A^^ (#12) ORDER CHECKS
^PS(52.49,D0,12,D1,0)= (#.01) ORDER CHECK NARRATIVE [1F] ^
^PS(52.49,D0,12,D1,1)= (#1) OVERRIDING PROVIDER [1F] ^
^PS(52.49,D0,12,D1,2,0)=^52.49122^^ (#2) OVERRIDING REASON
^PS(52.49,D0,12,D1,2,D2,0)= (#.01) OVERRIDING REASON [1W] ^
^PS(52.49,D0,13)= (#13.1) PATIENT FACILITY UNIT [1F] ^ (#13.2) BED [2F] ^ (#13.3) ROOM [3F] ^
^PS(52.49,D0,14,0)=^52.4914A^^ (#14) OBSERVATION
^PS(52.49,D0,14,D1,0)= (#.01) SEQUENCE [1N] ^ (#.02) DIMENSION [2F] ^ (#.03) VALUE [3N] ^ (#.04) OBSERVATION DATE [4D] ^ (#.05)
==>MEASURMENT DATA QUALIFIER [5N] ^ (#.06) MEASUREMENT SOURCE CODE [6F] ^ (#.07) MEASUREMENT UNIT CODE [7F] ^
^PS(52.49,D0,15)= (#15) OBSERVATION NOTES [1F] ^
^PS(52.49,D0,16,0)=^52.4916PA^^ (#16) DRUG USE EVALUATION
^PS(52.49,D0,16,D1,0)= (#.01) SERVICE REASON CODE [1P:52.45] ^ (#.02) PROFESSIONAL SERVICE CODE [2P:52.45] ^ (#.03) SERVICE
==>RESULT CODE [3P:52.45] ^ (#.04) COAGENT ID [4F] ^ (#.05) COAGENT QUALIFIER [5P:52.45] ^ (#.06) CLINICAL
==>SIGNIFICANCE CODE [6S] ^
^PS(52.49,D0,16,D1,1)= (#1) ACKNOWLEDGEMENT REASON [1F] ^
^PS(52.49,D0,17)= (#17.1) EXTERNAL PHARMACY [1P:52.47] ^ (#17.2) EXTERNAL PHARMACIST [2P:52.48] ^ (#17.3) TRANSFERRED TO VA
==>PHARMACY [3P:4] ^ (#17.4) XFER TO EXTERNAL PHARMACY [4P:52.47] ^
^PS(52.49,D0,18,0)=^52.4918A^^ (#18) PAYER INFORMATION
^PS(52.49,D0,18,D1,0)= (#.01) SEQUENCE [1N] ^ (#.02) GROUP ID [2F] ^ (#.03) PAYER NAME [3F] ^ (#.04) PAYER IDENTIFICATION NUMBER
==>[4F] ^
^PS(52.49,D0,18,D1,1)= (#1) LAST NAME [1F] ^ (#2) FIRST NAME [2F] ^ (#3) PAYER MIDDLE NAME [3F] ^ (#4) PAYER SUFFIX [4F] ^ (#5)
==>PAYER PREFIX [5F] ^
^PS(52.49,D0,18,D1,2)= (#7) CARDHOLDER ID [1F] ^
^PS(52.49,D0,18,D1,6,0)=^52.49186A^^ (#6) IDENTIFICATION
^PS(52.49,D0,18,D1,6,D2,0)= (#.01) ID TYPE [1F] ^ (#.02) ID VALUE [2F] ^
^PS(52.49,D0,19,0)=^52.4919DA^^ (#19) STATUS HISTORY
^PS(52.49,D0,19,D1,0)= (#.01) STATUS DATE/TIME [1D] ^ (#.02) STATUS [2P:52.45] ^ (#.03) ENTERED BY [3P:200] ^ (#.04) UN-ACCEPTED
==>ERX FLAG [4S] ^ (#.05) FUTURE FILL HOLD DATE [5D] ^
^PS(52.49,D0,19,D1,1)= (#1) STATUS COMMENTS [1F] ^
^PS(52.49,D0,20)= (#20.1) VISTA QUANTITY [1N] ^ (#20.2) VISTA DAYS SUPPLY [2N] ^ (#20.3) VISTA VERB [3F] ^ (#20.4) VISTA ROUTING
==>[4S] ^ (#20.5) VISTA REFILLS [5N] ^ (#20.6) VISTA CLINIC [6P:44] ^
^PS(52.49,D0,21,0)=^52.4921A^^ (#21) QUANTITY/TIMING
^PS(52.49,D0,21,D1,0)= (#.01) QUANTITY/FORM [1F] ^
^PS(52.49,D0,21,D1,1)= (#1) SCHEDULE [1F] ^ (#2) DURATION [2F] ^ (#3) START DATE/TIME [3D] ^ (#4) END DATE/TIME [4D] ^ (#12) NOUN
==>[5F] ^ (#6) CONJUNCTION [6S] ^ (#7) SEQUENCING [7F] ^ (#10) MED ROUTE [8P:51.2] ^ (#11) UNITS [9P:50.607]
==>^ (#13) VERB [10F] ^
^PS(52.49,D0,21,D1,2)= (#8) DOSAGE ORDERED [1F] ^ (#9) DISPENSE UNITS PER DOSE [2N] ^
^PS(52.49,D0,22)= (#22.1) FROM [1F] ^ (#22.2) FROM QUALIFIER [2S] ^ (#22.3) TO [3F] ^ (#22.4) TO QUALIFIER [4S] ^ (#22.5) CH SENT
==>DATE/TIME [5D] ^ (#70.1) FACILITY NAME [6F] ^ (#70.2) FACILITY ADDRESS LINE 1 [7F] ^ (#70.3) FACILITY ADDRESS
==>LINE 2 [8F] ^
^PS(52.49,D0,23)= (#70.4) FACILITY CITY [1F] ^
^PS(52.49,D0,24)= (#24.1) RELATED INSTITUTION [1P:4] ^ (#24.2) DIVISION [2P:40.8] ^ (#24.3) SENDER SECONDARY ID [3F] ^ (#24.4)
==>SENDER TERTIARY ID [4F] ^ (#24.5) RECEIVER SECONDARY ID [5F] ^ (#24.6) RECEIVER TERTIARY ID [6F] ^
^PS(52.49,D0,25)= (#25) CH MESSAGE ID [1F] ^ (#25.2) PENDING OUTPATIENT ORDER# [2N] ^ (#70.5) FACILITY STATE [3P:5] ^ (#70.6)
==>FACILITY ZIP CODE [4F] ^
^PS(52.49,D0,26,0)=^52.4971A^^ (#71) FACILITY IDENTIFICATION
^PS(52.49,D0,26,D1,0)= (#.01) ID TYPE [1F] ^ (#.02) ID VALUE [2F] ^
^PS(52.49,D0,27,0)=^52.4972A^^ (#72) COMMUNICATION
^PS(52.49,D0,27,D1,0)= (#.01) COMMUNICATION [1F] ^
^PS(52.49,D0,27,D1,1)= (#.02) TYPE [E1,2S] ^
^PS(52.49,D0,28,0)=^52.4928A^^ (#28) DRUG COVERAGE STATUS
^PS(52.49,D0,28,D1,0)= (#.01) SEQUENCE NUMBER [1N] ^ (#.02) DRUG COVERAGE STATUS [2P:52.45] ^
^PS(52.49,D0,29)= (#70.7) COUNTRY CODE [1F] ^
^PS(52.49,D0,30)= (#30) VA PROVIDER COMMENTS [1F] ^
^PS(52.49,D0,31,0)=^52.4931^^ (#31) VA UNEXPANDED SIG
^PS(52.49,D0,31,D1,0)= (#.01) VA UNEXPANDED SIG [1W] ^
^PS(52.49,D0,41)= (#41) EXTERNAL FORM CODE [1F] ^
^PS(52.49,D0,42)= (#42) EXTERNAL POTENCY UNIT CODE [1F] ^
^PS(52.49,D0,43)= (#43) EXTERNAL STRENTH CODE [1F] ^
^PS(52.49,D0,44)= (#44) PAYER CARDHOLDER ID CONVERTED? [1S] ^
^PS(52.49,D0,49,0)=^52.4949^^ (#49) MEDICATION DISPENSED/REQUESTED
^PS(52.49,D0,49,D1,0)= (#.01) MEDICATION DISPENSED/REQUESTED [1F] ^ (#.02) TYPE [2S] ^ (#.03) DRUG IEN [3P:50] ^ (#.04) QUANTITY
==>[4N] ^ (#.05) DAYS SUPPLY [5N] ^ (#.06) REFILLS [6N] ^ (#.07) REFILL QUALIFIER [7S] ^
^PS(52.49,D0,49,D1,1)= (#1) DIRECTIONS [1F] ^
^PS(52.49,D0,49,D1,2)= (#2.1) WRITTEN DATE [1D] ^ (#2.2) LAST FILLED DATE [2D] ^ (#2.3) EXPIRATION DATE [3D] ^ (#2.4) EFFECTIVE
==>DATE [4D] ^ (#2.5) CODE LIST QUALIFIER [5S] ^ (#2.6) UNIT SOURCE CODE [6S] ^ (#2.7) POTENCY UNIT CODE [7F]
==>^
^PS(52.49,D0,50)= (#50) REQUEST/RESPONSE COMMENTS [1F] ^
^PS(52.49,D0,50.1)= (#50.1) NOTE ADDED BY [1P:200] ^ (#50.2) NOTE DATE/TIME [2D] ^
^PS(52.49,D0,51)= (#51.1) REFILL/CHANGE REQUEST PERSON [1P:200] ^ (#51.2) # OF REFILLS REQUESTED [2N] ^
^PS(52.49,D0,52)= (#52.1) RESPONSE VALUE [1S] ^ (#52.2) RESPONSE NOTE [2F] ^ (#52.3) RESPONSE REFERENCE NUMBER [3F] ^
^PS(52.49,D0,55,0)=^52.4955P^^ (#55) RESPONSE CODES
^PS(52.49,D0,55,D1,0)= (#.01) RESPONSE CODES [1P:52.45] ^
^PS(52.49,D0,60)= (#60) REQUEST/RESPONSE ERROR TEXT [1F] ^ (#60.1) REQUEST/RESPONSE ERROR CODE [2S] ^
^PS(52.49,D0,61,0)=^52.4961P^^ (#61) REQUEST/RESPONSE ERR DCODES
^PS(52.49,D0,61,D1,0)= (#.01) REQUEST/RESPONSE ERR DCODES [1P:52.45] ^
^PS(52.49,D0,73,0)=^52.4973^^ (#73) 2017 FACILITY COMMUNICATION
^PS(52.49,D0,73,D1,0)= (#.01) SEQUENCE [1N] ^ (#.02) TYPE [2S] ^ (#.03) NUMBER [3N] ^ (#.04) EXTENSION [4N] ^ (#.05) SUPPORTS SMS
==>[5S] ^
^PS(52.49,D0,73,D1,1)= (#1) EMAIL ADDRESS [1F] ^
^PS(52.49,D0,74)= (#74.1) 2017 FAC NCPDPID [1F] ^ (#74.2) 2017 FAC STATE LIC NUMBER [2F] ^ (#74.3) 2017 FAC MEDICARE NUMBER [3F]
==>^ (#74.4) 2017 FAC MEDICAID NUMBER [4F] ^ (#74.5) 2017 FAC UPIN [5F] ^ (#74.6) 2017 FACILITY ID [6F] ^
^PS(52.49,D0,75)= (#75.1) 2017 FAC DEA NUMBER [1F] ^ (#75.2) 2017 FAC HIN [2F] ^ (#75.3) 2017 FAC NPI [3F] ^ (#75.4) 2017 FAC
==>MUTUALLY DEFINED [4F] ^ (#75.5) 2017 FAC REMS ENROLLMENT ID [5F] ^
^PS(52.49,D0,76)= (#76) 2017 FACILITY DIRECT ADDRESS [1F] ^
^PS(52.49,D0,80)= (#80.1) CHANGE REQUEST TYPE [1S] ^ (#80.2) RETURN RECEIPT [2F] ^ (#80.3) REQUEST REFERENCE NUMBER [3F] ^
==>(#80.4) CHANGE RX STATUS FLAG [4S] ^ (#80.5) CHANGE/CANCEL DENIED BY HUB [5S] ^
^PS(52.49,D0,95)= (#95.1) CONTROLLED SUBSTANCE INDICATOR [1S] ^ (#95.2) CS DIG SIGNATURE DIGEST METHOD [2F] ^ (#95.3) CS DIG
==>SIGNATURE DIGEST VALUE [3F] ^
^PS(52.49,D0,100,0)=^52.49101A^^ (#100) PROCESSING ERRORS
^PS(52.49,D0,100,D1,0)= (#.01) PROCESSING ERRORS [1N] ^ (#.02) ERROR TYPE [2S] ^ (#.03) ERROR SOURCE [3S] ^ (#.04) STATUS [4S] ^
==>(#.05) RESOLVED BY [5P:200] ^ (#.06) DATE/TIME RESOLVED [6D] ^
^PS(52.49,D0,100,D1,1)= (#1) ERROR TEXT [1F] ^
^PS(52.49,D0,201,0)=^52.49201P^^ (#201) MESSAGE HISTORY
^PS(52.49,D0,201,D1,0)= (#.01) MESSAGE IEN [1P:52.49] ^
^PS(52.49,D0,301)= (#301.1) 2017 LTC LEVEL OF CHANGE [1P:52.45] ^ (#301.2) 2017 URGENCY INDICATOR CODE [2S] ^ (#301.3) 2017
==>PROHIBIT RENEWAL REQUEST [3S] ^
^PS(52.49,D0,302)= (#302) 2017 NO KNOWN ALLERGIES [1S] ^
^PS(52.49,D0,303,0)=^52.49303^^ (#303) 2017 ALLERGIES
^PS(52.49,D0,303,D1,0)= (#.01) SEQUENCE [1N] ^ (#.02) SOURCE OF INFORMATION [2S] ^ (#.03) EFFECTIVE DATE [3D] ^ (#.04) EXPIRATION
==>DATE [4D] ^
^PS(52.49,D0,303,D1,1)= (#1) DRUG PRODUCT CODE [1F] ^
^PS(52.49,D0,303,D1,2)= (#2) DRUG PRODUCT QUALIFIER [1F] ^
^PS(52.49,D0,303,D1,3)= (#3) DRUG PRODUCT TEXT [1F] ^
^PS(52.49,D0,303,D1,4)= (#4) REACTION TEXT [1F] ^
^PS(52.49,D0,303,D1,5)= (#5) REACTION CODE [1F] ^
^PS(52.49,D0,303,D1,6)= (#6) SEVERITY TEXT [1F] ^
^PS(52.49,D0,303,D1,7)= (#7) SEVERITY CODE [1F] ^
^PS(52.49,D0,303,D1,8)= (#8) ADVERSE EVENT TEXT [1F] ^
^PS(52.49,D0,303,D1,9)= (#9) ADVERSE EVENT CODE [1F] ^
^PS(52.49,D0,304,0)=^52.49304^^ (#304) 2017 BENEFITS COORDINATION
^PS(52.49,D0,304,D1,0)= (#.01) SEQUENCE [1N] ^ (#.02) PAYER ID [2F] ^ (#.03) PROCESSOR ID NUMBER [3F] ^ (#.04) NAIC CODE [4F] ^
^PS(52.49,D0,304,D1,1)= (#1.1) MUTUALLY DEFINED [1F] ^ (#1.2) HEALTH PLAN IDENTIFIER [2F] ^ (#1.3) IIN NUMBER [3F] ^
^PS(52.49,D0,304,D1,2)= (#2.1) PAYER NAME [1F] ^ (#2.2) CARDHOLDER ID [2F] ^
^PS(52.49,D0,304,D1,3)= (#3.1) CARDHOLDER LAST NAME [1F] ^ (#3.2) CARDHOLDER FIRST NAME [2F] ^ (#3.3) CARDHOLDER MIDDLE NAME [3F]
==>^ (#3.4) CARDHOLDER SUFFIX [4F] ^ (#3.5) CARDHOLDER PREFIX [5F] ^
^PS(52.49,D0,304,D1,4)= (#4.1) GROUP ID [1F] ^ ^ (#4.3) PAYER RESPONSIBILITY CODE [3S] ^ (#4.4) PATIENT RELATIONSHIP CODE [4S] ^
==>(#4.5) PERSON CODE [5N] ^ (#4.6) GROUP NAME [6F] ^
^PS(52.49,D0,304,D1,5)= (#5.1) ADDRESS LINE 1 [1F] ^ (#5.2) ADDRESS LINE 2 [2F] ^ (#5.3) CITY [3F] ^ (#5.4) STATE/PROVINCE [4P:5]
==>^ (#5.5) POSTAL CODE [5F] ^ (#5.6) COUNTRY CODE [6F] ^
^PS(52.49,D0,304,D1,6,0)=^52.493046^^ (#6) 2017 BENEFITS COMM
^PS(52.49,D0,304,D1,6,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) TYPE [2S] ^ (#.03) NUMBER [3N] ^ (#.04) EXTENSION [4N] ^ (#.05)
==>SUPPORTS SMS [5S] ^
^PS(52.49,D0,304,D1,6,D2,1)= (#1) EMAIL ADDRESS [1F] ^
^PS(52.49,D0,304,D1,7)= (#7) 2017 BENEFITS DIRECT ADDRESS [1F] ^
^PS(52.49,D0,304,D1,15)= (#15.1) PBM MEMBER ID [1F] ^
^PS(52.49,D0,304,D1,16)= (#16.1) RESPONSIBLE PARTY LAST NAME [1F] ^ (#16.2) RESPONSIBLE PARTY FIRST NAME [2F] ^ (#16.3)
==>RESPONSIBLE PARTY MIDDLE NAME [3F] ^ (#16.4) RESPONSIBLE PARTY SUFFIX [4F] ^ (#16.5) RESPONSIBLE PARTY
==>PREFIX [5F] ^ (#16.6) PAYER TYPE [6P:52.45] ^
^PS(52.49,D0,305)= (#305) 2017 OBSERVATION NOTES [1F] ^
^PS(52.49,D0,306,0)=^52.49306^^ (#306) 2017 OBSERVATION
^PS(52.49,D0,306,D1,0)= (#.01) SEQUENCE [1N] ^
^PS(52.49,D0,306,D1,1)= (#1) VITAL SIGN [1F] ^
^PS(52.49,D0,306,D1,2)= (#2) LOINC VERSION [1F] ^
^PS(52.49,D0,306,D1,3)= (#3) VALUE [1F] ^
^PS(52.49,D0,306,D1,4)= (#4) UNIT OF MEASURE [1F] ^
^PS(52.49,D0,306,D1,5)= (#5) UCUM VERSION [1F] ^
^PS(52.49,D0,306,D1,6)= (#6) OBSERVATION DATE [1D] ^
^PS(52.49,D0,307)= (#307.1) 2017 FOLLOW-UP PRESCRIBER [1P:52.48] ^
^PS(52.49,D0,311,0)=^52.49311^^ (#311) 2017 MEDICATIONS
^PS(52.49,D0,311,D1,0)= (#.01) SEQUENCE [1N] ^ (#.02) TYPE [2S] ^ (#.03) DRUG DESCRIPTION [3F] ^
^PS(52.49,D0,311,D1,1)= (#1.1) DC PRODUCT CODE [1F] ^ (#1.2) DC PRODUCT CODE QUALIFIER [2P:52.45] ^ (#1.3) DC STRENGTH VALUE [3F]
==>^ (#1.4) DC STRENGTH FORM [4P:52.45] ^ (#1.5) DC STRENGTH UNIT OF MEASURE [5P:52.45] ^ (#1.6) DC DRUG DB
==>CODE [6F] ^ (#1.7) DC DRUG DB QUALIFIER [7P:52.45] ^ (#1.8) DC DEA SCHEDULE CODE [8P:52.45] ^
^PS(52.49,D0,311,D1,2)= (#2.1) QUANTITY VALUE [1N] ^ (#2.2) QUANTITY CODE LIST QUALIFIER [2P:52.45] ^ (#2.3) QUANTITY UNIT OF
==>MEASURE [3P:52.45] ^ (#2.4) DAYS SUPPLY [4N] ^ (#2.5) WRITTEN DATE [5D] ^ (#2.6) LAST FILL DATE [6D] ^
==>(#2.7) SUBSTITUTIONS [7S] ^ (#2.8) NUMBER OF REFILLS [8N] ^
^PS(52.49,D0,311,D1,3,0)=^52.493113^^ (#3) 2017 DIAGNOSIS
^PS(52.49,D0,311,D1,3,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) CLINICAL INFO QUALIFIER [2S] ^
^PS(52.49,D0,311,D1,3,D2,1)= (#1.1) PRIMARY DX CODE [1F] ^ (#1.2) PRIMARY DIAGNOSIS QUALIFIER [2S] ^ (#1.3) PRIMARY OFFICE VISIT
==>DATE [3D] ^
^PS(52.49,D0,311,D1,3,D2,2)= (#2) PRIMARY DX DESCRIPTION [1F] ^
^PS(52.49,D0,311,D1,3,D2,3)= (#3.1) SECONDARY DX CODE [1F] ^ (#3.2) SECONDARY DX QUALIFIER [2S] ^ (#3.3) SECONDARY OFFICE VISIT
==>DATE [3D] ^
^PS(52.49,D0,311,D1,3,D2,4)= (#4) SECONDARY DX DESCRIPTION [1F] ^
^PS(52.49,D0,311,D1,4)= (#4.1) PRIOR AUTHORIZATION [1F] ^ (#4.2) PRIOR AUTHORIZATION STATUS [2S] ^ (#4.3) PHARMACY REQUESTED
==>REFILLS [3N] ^ (#4.4) REASON FOR SUBSTITUTION CODE [4F] ^
^PS(52.49,D0,311,D1,5)= (#5) NOTE [1F] ^
^PS(52.49,D0,311,D1,6,0)=^52.493116^^ (#6) DRUG USE EVALUATION
^PS(52.49,D0,311,D1,6,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) DUE SERVICE REASON CODE [2P:52.45] ^ (#.03) DUE PROF SERVICE CODE
==>[3P:52.45] ^ (#.04) DUE SVX RESULT CODE [4P:52.45] ^ (#.05) DUE COAGENT CODE [5F] ^ (#.06) DUE
==>COAGENT QUALIFIER [6P:52.45] ^ (#.07) DUE CLINICAL SIGNIFICANCE CODE [7S] ^
^PS(52.49,D0,311,D1,6,D2,1)= (#1) DUE COAGENT DESCRIPTION [1F] ^
^PS(52.49,D0,311,D1,6,D2,2)= (#2) DUE ACKNOWLEDGEMENT REASON [1F] ^
^PS(52.49,D0,311,D1,7,0)=^52.493117^^ (#7) DRUG COVERAGE STATUS
^PS(52.49,D0,311,D1,7,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) DRUG COVERAGE STATUS [2P:52.45] ^
^PS(52.49,D0,311,D1,8,0)=^52.493118^^ (#8) SIG TEXT
^PS(52.49,D0,311,D1,8,D2,0)= (#.01) SIG TEXT [1W] ^
^PS(52.49,D0,311,D1,9)= (#9.1) SNOMED VERSION [1F] ^ (#9.2) FMT VERSION [2F] ^
^PS(52.49,D0,311,D1,12,0)=^52.4931112^^ (#12) INSTRUCTIONS
^PS(52.49,D0,311,D1,12,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) INSTRUCTION INDICATOR [2S] ^ (#.03) MULTIPLE INSTRUCTION MODIFIER
==>[3F] ^
^PS(52.49,D0,311,D1,12,D2,3,0)=^52.49311123^^ (#3) TIMING AND DURATION
^PS(52.49,D0,311,D1,12,D2,3,D3,0)= (#.01) SEQUENCE [1N] ^ (#.02) MULT TIMING MODIFIER [2S] ^ (#.03) ADMIN TIMING VALUE 1 [3F] ^
==>(#.04) VARIABLE ADMIN TIMING MODIFIER [4F] ^ (#.05) ADMIN TIMING VALUE 2 [5F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,1)= (#1) ADMIN TIMING UNITS CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,2)= (#2) ADMIN TIMING UNITS QUALIFIER [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,3)= (#3) ADMIN TIMING UNITS TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,4)= (#4) ADMIN TIMING MODIFIER CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,5)= (#5) ADMIN TIMING MODIFIER QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,6)= (#6) ADMIN TIMING MODIFIER TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,7)= (#7) ADMIN TIMING EVENT CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,8)= (#8) ADMIN TIMING EVENT QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,9)= (#9) ADMIN TIMING EVENT TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,10)= (#10) ADMIN TIMING EVENT FREE TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,11)= (#11.1) FREQ NUMERIC VALUE 1 [1F] ^ (#11.2) FREQ MODIFIER [2S] ^ (#11.3) FREQ NUMERIC VALUE 2
==>[3F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,12)= (#12) FREQ UNITS CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,13)= (#13) FREQ UNITS QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,14)= (#14) FREQUENCY UNITS TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,15)= (#15.1) INT NUMERIC VALUE 1 [1F] ^ (#15.2) INT MODIFIER [2S] ^ (#15.3) INT NUMERIC VALUE 2
==>[3F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,16)= (#16) INT UNITS CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,17)= (#17) INT UNITS QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,18)= (#18) INT UNITS TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,21)= (#21.1) RATE OF ADMIN [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,22)= (#22) RATE UNIT MEASURE CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,23)= (#23) RATE UNIT MEASURE QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,24)= (#24) RATE UNIT MEASURE TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,25)= (#25) ROA TIME BASIS CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,26)= (#26) ROA TIME BASIS QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,27)= (#27) ROA TIME BASIS TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,28)= (#28) TIMING FREE TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,31)= (#31) DURATION VALUE [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,32)= (#32) DURATION CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,33)= (#33) DURATION QUALIFIER [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,34)= (#34) DURATION TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,35)= (#35) DURATION TRIGGER CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,36)= (#36) DURATION TRIGGER QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,37)= (#37) DURATION TRIGGER TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,38)= (#38) DURATION CLARIFYING TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,41)= (#41) STOP INDICATOR CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,42)= (#42) STOP INDICATOR QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,3,D3,43)= (#43) STOP INDICATOR TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,4)= (#4.1) ADMIN INDICATOR [1S] ^
^PS(52.49,D0,311,D1,12,D2,7)= (#7) DDM CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,8)= (#8) DDM QUALIFIER [1F] ^
^PS(52.49,D0,311,D1,12,D2,9)= (#9) DDM TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,10)= (#10.1) DOSE QUANTITY 1 [1F] ^
^PS(52.49,D0,311,D1,12,D2,11)= (#11) DUOM CODE 1 [1F] ^
^PS(52.49,D0,311,D1,12,D2,12)= (#12) DUOM QUALIFIER 1 [1F] ^
^PS(52.49,D0,311,D1,12,D2,13)= (#13) DUOM TEXT 1 [1F] ^
^PS(52.49,D0,311,D1,12,D2,14)= (#14) DOSE RANGE MODIFIER [1S] ^
^PS(52.49,D0,311,D1,12,D2,15)= (#15.1) DOSE QUANTITY 2 [1F] ^
^PS(52.49,D0,311,D1,12,D2,16)= (#16) DUOM CODE 2 [1F] ^
^PS(52.49,D0,311,D1,12,D2,17)= (#17) DUOM QUALIFIER 2 [1F] ^
^PS(52.49,D0,311,D1,12,D2,18)= (#18) DUOM TEXT 2 [1F] ^
^PS(52.49,D0,311,D1,12,D2,21)= (#21.1) DOSE BASIS NUMERIC VALUE [1F] ^ (#21.2) DOSE BASIS RANGE MODIFIER [2S] ^ (#21.3) DOSE
==>BASIS NUM VALUE 2 [3F] ^
^PS(52.49,D0,311,D1,12,D2,22)= (#22) DBUOM CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,23)= (#23) DBUOM QUALIFIER [1F] ^
^PS(52.49,D0,311,D1,12,D2,24)= (#24) DBUOM TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,25)= (#25.1) BODY METRIC QUAL [1S] ^ (#25.2) BODY METRIC VALUE [2F] ^
^PS(52.49,D0,311,D1,12,D2,26)= (#26) CALCULATED DOSE NUMERIC [1F] ^
^PS(52.49,D0,311,D1,12,D2,27)= (#27) CDUOM CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,28)= (#28) CDUOM QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,29)= (#29) CDUOM TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,31)= (#31) DOSE CALC CLARIFYING TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,32)= (#32) DUOMCODE CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,33)= (#33) DUOMCODE QUALIFIER [1F] ^
^PS(52.49,D0,311,D1,12,D2,34)= (#34) DUOMCODE TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,35)= (#35) DOSE AMOUNT CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,36)= (#36) DOSE AMOUNT QUALIFIER [1F] ^
^PS(52.49,D0,311,D1,12,D2,37)= (#37) DOSE AMOUNT TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,38)= (#38) DOSE CLARIFYING FREE TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,41)= (#41) VEHICLE PREPOSITION CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,42)= (#42) VEHICLE PREPOSITION QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,43)= (#43) VEHICLE PREPOSITION TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,44)= (#44.1) VEHICLE QUANTITY 1 [1F] ^ (#44.2) MULTIPLE VEHICLE MODIFIER [2S] ^ (#44.3) VEHICLE
==>QUANTITY 2 [3F] ^
^PS(52.49,D0,311,D1,12,D2,45)= (#45) VEHICLE UOM CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,46)= (#46) VEHICLE UOM QUALIFIER [1F] ^
^PS(52.49,D0,311,D1,12,D2,47)= (#47) VEHICLE UOM TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,51)= (#51) VEHICLE CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,52)= (#52) VEHICLE QUALIFIER [1F] ^
^PS(52.49,D0,311,D1,12,D2,53)= (#53) VEHICLE TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,54)= (#54) VEHICLE CLARIFYING TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,55)= (#55) ROUTE OF ADMIN CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,56)= (#56) ROUTE OF ADMIN QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,57)= (#57) ROUTE OF ADMIN TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,58)= (#58) RTE OF ADMIN FREE TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,61)= (#61) SITE OF ADMIN CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,62)= (#62) SITE OF ADMIN QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,63)= (#63) SITE OF ADMIN TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,64)= (#64) SITE OF ADMIN CLARIFYING TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,0)=^52.493111267^^ (#67) INDICATION FOR USE
^PS(52.49,D0,311,D1,12,D2,67,D3,0)= (#.01) SEQUENCE [1N] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,1)= (#1) INDICATION PRECURSOR CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,2)= (#2) INDICATION PRECURSOR QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,3)= (#3) INDICATION PRECURSOR TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,4)= (#4) INDICATION CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,5)= (#5) INDICATION QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,6)= (#6) INDICATION TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,7)= (#7) INDICATION VALUE CODE 1 [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,8)= (#8) INDICATION VALUE QUAL 1 [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,9)= (#9) INDICATION VALUE TEXT 1 [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,10)= (#10) INDICATION VARIABLE MODIFIER [1S] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,11)= (#11) INDICATION VALUE CODE 2 [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,12)= (#12) INDICATION VALUE QUAL 2 [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,13)= (#13) INDICATION VALUE TEXT 2 [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,14)= (#14) INDICATION VALUE UNIT CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,15)= (#15) INDICATION VALUE UNIT QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,16)= (#16) INDICATION VALUE UNIT TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,17)= (#17) INDICATION UOM CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,18)= (#18) INDICATION UOM QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,67,D3,19)= (#19) INDICATION UOM TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,70)= (#70) INDICATION CLARIFYING TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,71)= (#71) MDR CLARIFYING FREE TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,72)= (#72) DDMM CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,73)= (#73) DDMM QUALIFIER [1F] ^
^PS(52.49,D0,311,D1,12,D2,74)= (#74) DDMM TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,75,0)=^52.493111275^^ (#75) MAX DOSE RESTRICTION
^PS(52.49,D0,311,D1,12,D2,75,D3,0)= (#.01) SEQUENCE [1N] ^
^PS(52.49,D0,311,D1,12,D2,75,D3,1)= (#1) NUMERIC VALUE 1 [1F] ^
^PS(52.49,D0,311,D1,12,D2,75,D3,2)= (#2) RESTRICTION UNITS CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,75,D3,3)= (#3) RESTRICTION UNITS QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,75,D3,4)= (#4) RESTRICTION UNITS TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,75,D3,5)= (#5) DURATION VALUE [1F] ^
^PS(52.49,D0,311,D1,12,D2,75,D3,6)= (#6) DURATION UNITS CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,75,D3,7)= (#7) DURATION UNITS QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,75,D3,8)= (#8) DURATION UNITS TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,75,D3,9)= (#9) RESTRICTION FORM CODE [1F] ^
^PS(52.49,D0,311,D1,12,D2,75,D3,10)= (#10) RESTRICTION FORM QUAL [1F] ^
^PS(52.49,D0,311,D1,12,D2,75,D3,11)= (#11) RESTRICTION FORM TEXT [1F] ^
^PS(52.49,D0,311,D1,12,D2,75,D3,12)= (#12) CLARIFYING FREE TEXT [1F] ^
^PS(52.49,D0,311,D1,13,0)=^52.4931113^^ (#13) INDICATION FOR USE
^PS(52.49,D0,311,D1,13,D2,0)= (#.01) SEQUENCE [1N] ^
^PS(52.49,D0,311,D1,13,D2,1)= (#1) INDICATION PRECURSOR CODE [1F] ^
^PS(52.49,D0,311,D1,13,D2,2)= (#2) INDICATION PRECURSOR QUAL [1F] ^
^PS(52.49,D0,311,D1,13,D2,3)= (#3) INDICATION PRECURSOR TEXT [1F] ^
^PS(52.49,D0,311,D1,13,D2,4)= (#4) INDICATION CODE [1F] ^
^PS(52.49,D0,311,D1,13,D2,5)= (#5) INDICATION QUAL [1F] ^
^PS(52.49,D0,311,D1,13,D2,6)= (#6) INDICATION TEXT [1F] ^
^PS(52.49,D0,311,D1,13,D2,7)= (#7) INDICATION VALUE CODE 1 [1F] ^
^PS(52.49,D0,311,D1,13,D2,8)= (#8) INDICATION VALUE QUAL 1 [1F] ^
^PS(52.49,D0,311,D1,13,D2,9)= (#9) INDICATION VALUE TEXT 1 [1F] ^
^PS(52.49,D0,311,D1,13,D2,10)= (#10) INDICATION VARIABLE MODIFIER [1S] ^
^PS(52.49,D0,311,D1,13,D2,11)= (#11) INDICATION VALUE CODE 2 [1F] ^
^PS(52.49,D0,311,D1,13,D2,12)= (#12) INDICATION VALUE QUAL 2 [1F] ^
^PS(52.49,D0,311,D1,13,D2,13)= (#13) INDICATION VALUE TEXT 2 [1F] ^
^PS(52.49,D0,311,D1,13,D2,14)= (#14) INDICATION VALUE UNIT CODE [1F] ^
^PS(52.49,D0,311,D1,13,D2,15)= (#15) INDICATION VALUE UNIT QUAL [1F] ^
^PS(52.49,D0,311,D1,13,D2,16)= (#16) INDICATION VALUE UNIT TEXT [1F] ^
^PS(52.49,D0,311,D1,13,D2,17)= (#17) INDICATION UOM CODE [1F] ^
^PS(52.49,D0,311,D1,13,D2,18)= (#18) INDICATION UOM QUAL [1F] ^
^PS(52.49,D0,311,D1,13,D2,19)= (#19) INDICATION UOM TEXT [1F] ^
^PS(52.49,D0,311,D1,14,0)=^52.4931114^^ (#14) MAXIMUM DOSE RESTRICTION
^PS(52.49,D0,311,D1,14,D2,0)= (#.01) SEQUENCE [1N] ^
^PS(52.49,D0,311,D1,14,D2,1)= (#1) NUMERIC VALUE 1 [1F] ^
^PS(52.49,D0,311,D1,14,D2,2)= (#2) RESTRICTION UNITS CODE [1F] ^
^PS(52.49,D0,311,D1,14,D2,3)= (#3) RESTRICTION UNITS QUAL [1F] ^
^PS(52.49,D0,311,D1,14,D2,4)= (#4) RESTRICTION UNITS TEXT [1F] ^
^PS(52.49,D0,311,D1,14,D2,5)= (#5) DURATION VALUE [1F] ^
^PS(52.49,D0,311,D1,14,D2,6)= (#6) DURATION UNITS CODE [1F] ^
^PS(52.49,D0,311,D1,14,D2,7)= (#7) DURATION UNITS QUAL [1F] ^
^PS(52.49,D0,311,D1,14,D2,8)= (#8) DURATION UNITS TEXT [1F] ^
^PS(52.49,D0,311,D1,14,D2,9)= (#9) RESTRICTION FORM CODE [1F] ^
^PS(52.49,D0,311,D1,14,D2,10)= (#10) RESTRICTION FORM QUALIFIER [1F] ^
^PS(52.49,D0,311,D1,14,D2,11)= (#11) RESTRICTION FORM TEXT [1F] ^
^PS(52.49,D0,311,D1,14,D2,12)= (#12) CLARIFYING FREE TEXT [1F] ^
^PS(52.49,D0,311,D1,15)= (#15) SIG CLARIFYING FREE TEXT [1F] ^
^PS(52.49,D0,311,D1,16)= (#16.1) DO NOT FILL [1S] ^ (#16.2) TIME ZONE IDENTIFIER [2S] ^ (#16.3) TIME ZONE DIFF QTY [3F] ^ (#16.4)
==>ORDER CAPTURE METHOD [4S] ^ (#16.5) REASON FOR SUBSTITUTIONS [5S] ^ (#16.6) SPLIT SCRIPT [6S] ^ (#16.7)
==>RX FILL INDICATOR [7F] ^
^PS(52.49,D0,311,D1,17,0)=^52.4931117^^ (#17) OFFICE OF PHARMACY AFFAIRS
^PS(52.49,D0,311,D1,17,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) PHARMACY AFFAIRS ID [2F] ^
^PS(52.49,D0,311,D1,18)= (#18.1) DELIVERY REQUEST [1S] ^ (#18.2) DELIVERY LOCATION [2S] ^
^PS(52.49,D0,311,D1,19)= (#19.1) DIAB SPLY TEST FREQ [1N] ^ (#19.2) DIAB SPLY INDICATOR [2S] ^ (#19.3) DIAB INSULIN DEPENDENT
==>[3S] ^ (#19.4) DIAB HAS AUTO DEVICE [4S] ^ (#19.5) DIAB SPLY FREQ NOTES [5F] ^
^PS(52.49,D0,311,D1,20)= (#20.1) INJURY RELATED [1S] ^
^PS(52.49,D0,311,D1,21)= (#21.1) AGNCY OF SVC BUSINESS NAME [1F] ^ (#21.2) AGNCY OF SVC ADDRESS LINE 1 [2F] ^ (#21.3) AGNCY OF
==>SVC ADDRESS LINE 2 [3F] ^ (#21.4) AGNCY OF SVC CITY [4F] ^ (#21.5) AGNCY OF SVC STATE/PROVINCE [5F] ^
==>(#21.6) AGNCY OF SVC POSTAL CODE [6F] ^ (#21.7) AGNCY OF SVC COUNTRY CODE [7F] ^
^PS(52.49,D0,311,D1,25,0)=^52.4931125^^ (#25) 2017 AGNCY OF SVC COMM
^PS(52.49,D0,311,D1,25,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) TYPE [2S] ^ (#.03) NUMBER [3N] ^ (#.04) EXTENSION [4N] ^ (#.05)
==>SUPPORTS SMS [5S] ^
^PS(52.49,D0,311,D1,25,D2,1)= (#1) EMAIL ADDRESS [1F] ^
^PS(52.49,D0,311,D1,26)= (#26) 2017 AGNCY OF SVC DIR ADD [1F] ^
^PS(52.49,D0,311,D1,27)= (#27.1) AGNCY CONTACT LAST NAME [1F] ^ (#27.2) AGNCY CONTACT FIRST NAME [2F] ^ (#27.3) AGNCY CONTACT
==>MIDDLE NAME [3F] ^ (#27.4) AGNCY CONTACT SUFFIX [4F] ^ (#27.5) AGNCY CONTACT PREFIX [5F] ^
^PS(52.49,D0,311,D1,28)= (#28) IV ADMIN # OF LUMENS [1F] ^
^PS(52.49,D0,311,D1,29)= (#29.1) IV ADMIN DILUENT QTY [1N] ^ (#29.2) IV ADMIN DILUENT QUALIFIER [2P:52.45] ^ (#29.3) IV ADMIN
==>DILUENT QUOM [3P:52.45] ^
^PS(52.49,D0,311,D1,30)= (#30) IV SPEC ADMIN GAUGE [1N] ^
^PS(52.49,D0,311,D1,31)= (#31) IV SPEC ADMIN BRAND [1F] ^
^PS(52.49,D0,311,D1,32)= (#32) IV SPEC ADMIN LENGTH [1F] ^
^PS(52.49,D0,311,D1,33)= (#33.1) IV SPEC ADMIN PUMP [1S] ^
^PS(52.49,D0,311,D1,34)= (#34.1) IVA TYPE CODE [1F] ^
^PS(52.49,D0,311,D1,35)= (#35) IVA TYPE TEXT [1F] ^
^PS(52.49,D0,311,D1,36)= (#36) IVA DEVICE DESCRIPTION [1F] ^
^PS(52.49,D0,311,D1,37)= (#37.1) IVA DEVICE TYPE CODE [1F] ^
^PS(52.49,D0,311,D1,38)= (#38) IVA DEVICE TYPE TEXT [1F] ^
^PS(52.49,D0,311,D1,39)= (#39.1) IVA CATHETER TIP CODE [1F] ^
^PS(52.49,D0,311,D1,40)= (#40) IVA CATHETER TIP TEXT [1F] ^
^PS(52.49,D0,311,D1,41)= (#41) IVA CATHETER TIP DESC [1F] ^
^PS(52.49,D0,311,D1,42)= (#42.1) IV INFUSION CODE [1F] ^
^PS(52.49,D0,311,D1,43)= (#43) IV INFUSION TEXT [1F] ^
^PS(52.49,D0,311,D1,44)= (#44) IV INFUSION DESCRIPTION [1F] ^
^PS(52.49,D0,311,D1,45)= (#45.1) TREATMENT INDICATOR [1S] ^ (#45.2) PROPHYLACTIC OR EPISODIC [2S] ^ (#45.3) CURRENT TREATMENT
==>CYCLE [3N] ^ (#45.4) NUMBER OF CYCLES PLANNED [4N] ^
^PS(52.49,D0,311,D1,46,0)=^52.4931146^^ (#46) WOUND
^PS(52.49,D0,311,D1,46,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) LOCATION CODE [2F] ^
^PS(52.49,D0,311,D1,46,D2,1)= (#1) LOCATION TEXT [1F] ^
^PS(52.49,D0,311,D1,46,D2,2)= (#2.1) LATERALITY CODE [1S] ^
^PS(52.49,D0,311,D1,46,D2,3)= (#3) LATERALITY CODE TEXT [1F] ^
^PS(52.49,D0,311,D1,46,D2,4)= (#4.1) LENGTH [1F] ^ (#4.2) WIDTH [2F] ^ (#4.3) DEPTH [3F] ^
^PS(52.49,D0,311,D1,47)= (#47) PRESCRIBER CHECKED REMS [1S] ^
^PS(52.49,D0,311,D1,48)= (#48.1) REMS PATIENT RISK CATEGORY [1F] ^ (#48.2) REMS AUTHORIZATION [2F] ^
^PS(52.49,D0,311,D1,49)= (#49.1) PHARMACY TO TITRATE DOSE [1S] ^
^PS(52.49,D0,311,D1,51,0)=^52.4931151^^ (#51) TITRATION DOSE MEASUREMENT
^PS(52.49,D0,311,D1,51,D2,0)= (#.01) SEQUENCE [1N] ^
^PS(52.49,D0,311,D1,51,D2,1)= (#1) VITAL SIGN [1F] ^
^PS(52.49,D0,311,D1,51,D2,2)= (#2) LOINC VERSION [1F] ^
^PS(52.49,D0,311,D1,51,D2,3)= (#3) VALUE [1F] ^
^PS(52.49,D0,311,D1,51,D2,4)= (#4) UNIT OF MEASURE [1F] ^
^PS(52.49,D0,311,D1,51,D2,5)= (#5.1) MIN MEASUREMENT VALUE [1F] ^ (#5.2) MAX MEASUREMENT VALUE [2F] ^
^PS(52.49,D0,311,D1,51,D2,6)= (#6) MEASUREMENT NOTES [1F] ^
^PS(52.49,D0,311,D1,51,D2,7)= (#7.1) MEASUREMENT TIMING VALUE [1F] ^ (#7.2) VAR MEASUREMENT TIMING MOD [2S] ^ (#7.3) ADMIN TIMING
==>VALUE [3F] ^
^PS(52.49,D0,311,D1,51,D2,8)= (#8) MEAS TIMING UNITS TEXT [1F] ^
^PS(52.49,D0,311,D1,51,D2,9)= (#9) MEAS TIMING UNITS QUAL [1F] ^
^PS(52.49,D0,311,D1,51,D2,10)= (#10) MEAS TIMING UNITS CODE [1F] ^
^PS(52.49,D0,311,D1,51,D2,11)= (#11) MEAS TIMING MOD TEXT [1F] ^
^PS(52.49,D0,311,D1,51,D2,12)= (#12) MEAS TIMING MOD QUAL [1F] ^
^PS(52.49,D0,311,D1,51,D2,13)= (#13) MEAS TIMING MOD CODE [1F] ^
^PS(52.49,D0,311,D1,51,D2,14)= (#14) MEAS TIMING EVENT TEXT [1F] ^
^PS(52.49,D0,311,D1,51,D2,15)= (#15) MEAS TIMING EVENT QUAL [1F] ^
^PS(52.49,D0,311,D1,51,D2,16)= (#16) MEAS TIMING EVENT CODE [1F] ^
^PS(52.49,D0,311,D1,51,D2,17)= (#17) MEAS TIMING CLARIFYING TEXT [1F] ^
^PS(52.49,D0,311,D1,51,D2,18)= (#18.1) MEAS FREQ NUMERIC VALUE [1F] ^ (#18.2) MEAS VARIABLE FREQ MOD [2S] ^ (#18.3) MEAS FREQ
==>NUMERIC VALUE 2 [3F] ^
^PS(52.49,D0,311,D1,51,D2,19)= (#19) MEAS FREQ UNITS TEXT [1F] ^
^PS(52.49,D0,311,D1,51,D2,20)= (#20) MEAS FREQ UNITS QUAL [1F] ^
^PS(52.49,D0,311,D1,51,D2,21)= (#21) MEAS FREQ UNITS CODE [1F] ^
^PS(52.49,D0,311,D1,51,D2,22)= (#22.1) MEAS INTERVAL NUMERIC VALUE [1F] ^ (#22.2) MEAS INTERVAL MODIFIER [2S] ^ (#22.3) MEAS
==>INTERVAL NUMERIC VALUE 2 [3F] ^
^PS(52.49,D0,311,D1,51,D2,23)= (#23) MEAS INTERVAL UNITS TEXT [1F] ^
^PS(52.49,D0,311,D1,51,D2,24)= (#24) MEAS INTERVAL UNITS QUAL [1F] ^
^PS(52.49,D0,311,D1,51,D2,25)= (#25) MEAS INTERVAL UNITS CODE [1F] ^
^PS(52.49,D0,311,D1,51,D2,26)= (#26) MEAS DURATION VALUE [1F] ^
^PS(52.49,D0,311,D1,51,D2,27)= (#27) MEAS DURATION TEXT [1F] ^
^PS(52.49,D0,311,D1,51,D2,28)= (#28) MEAS DURATION QUAL [1F] ^
^PS(52.49,D0,311,D1,51,D2,29)= (#29) MEAS DURATION CODE [1F] ^
^PS(52.49,D0,311,D1,51,D2,30)= (#30) MEAS DURATION TRIGGER TEXT [1F] ^
^PS(52.49,D0,311,D1,51,D2,31)= (#31) MEAS DURATION TRIGGER QUAL [1F] ^
^PS(52.49,D0,311,D1,51,D2,32)= (#32) MEAS DURATION TRIGGER CODE [1F] ^
^PS(52.49,D0,311,D1,51,D2,33)= (#33) MEAS DUR CLARIFYING TEXT [1F] ^
^PS(52.49,D0,311,D1,51,D2,34)= (#34) UCUM VERSION [1F] ^
^PS(52.49,D0,311,D1,55)= (#55.1) FLAVORING REQUESTED [1S] ^
^PS(52.49,D0,311,D1,56)= (#56.1) COMPOUND PHARM DOSAGE FORM [1F] ^
^PS(52.49,D0,311,D1,57,0)=^52.4931157^^ (#57) COMPOUND ING LOT NOT USED
^PS(52.49,D0,311,D1,57,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) COMP INGREDIENT ITEM DESC [2F] ^ (#.03) ITEM NUMBER CODE [3F] ^
==>(#.04) ITEM NUMBER QUALIFIER [4P:52.45] ^
^PS(52.49,D0,311,D1,57,D2,1)= (#1.1) STRENGTH VALUE [1F] ^ (#1.2) STRENGTH FORM [2P:52.45] ^ (#1.3) STRENGTH UNIT OF MEASURE
==>[3P:52.45] ^ (#1.4) DEA SCHEDULE CODE [4P:52.45] ^
^PS(52.49,D0,311,D1,57,D2,2)= (#2.1) COMPOUND QTY VALUE [1N] ^ (#2.2) COMPOUND QTY CODE QUAL [2P:52.45] ^ (#2.3) COMPOUND QTY UOM
==>[3P:52.45] ^
^PS(52.49,D0,311,D1,57,D2,3)= (#3.1) SVX REASON CODE [1P:52.45] ^ (#3.2) PROF SVX CODE [2P:52.45] ^ (#3.3) SVX RESULT CODE
==>[3P:52.45] ^ (#3.4) COAGENT CODE [4F] ^ (#3.5) COAGENT QUALIFIER [5P:52.45] ^ (#3.6) CLINICAL
==>SIGNIFICANCE CODE [6S] ^ (#3.7) ACKNOWLEDGEMENT REASON [7F] ^
^PS(52.49,D0,311,D1,57,D2,4)= (#4) COAGENT DESCRIPTION [1F] ^
^PS(52.49,D0,311,D1,58)= (#58.1) # OF PACKAGES TO BE DISPENSED [1N] ^
^PS(52.49,D0,311,D1,59,0)=^52.4931159^^ (#59) PATIENT CODIFIED NOTES
^PS(52.49,D0,311,D1,59,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) QUALIFIER [2P:52.45] ^ (#.03) VALUE [3N] ^
^PS(52.49,D0,311,D1,61,0)=^52.4931161^^ (#61) FACILITY SPEC ADMIN TIMING
^PS(52.49,D0,311,D1,61,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) HOURS OF ADMIN VALUE [2N] ^
^PS(52.49,D0,311,D1,61,D2,1)= (#1) HOURS OF ADMINISTRATION TEXT [1F] ^
^PS(52.49,D0,311,D1,61,D2,2)= (#2.1) HOURS OF ADMIN QUALIFIER [1F] ^ (#2.2) HOURS OF ADMIN CODE [2F] ^
^PS(52.49,D0,311,D1,62,0)=^52.4931162^^ (#62) OTHER MEDICATION DATE
^PS(52.49,D0,311,D1,62,D2,0)= (#.01) SEQUENCE [1N] ^ (#.02) DATE [2D] ^ (#.03) QUALIFIER [3F] ^
^PS(52.49,D0,311,D1,63)= (#63.1) NEED NO LATER THAN DT [1F] ^ (#63.2) NEED NO LATER THAN REASON [2F] ^ (#63.3) PSO NON SELF ADMIN
==>PRODUCT [3N] ^ (#63.4) PROVIDER EXP AUTH TO ADMIN [4S] ^
^PS(52.49,D0,311,D1,64)= (#64) TYPE OF SVC FREE TEXT [1F] ^
^PS(52.49,D0,311,D1,65)= (#65) TYPE OF SVC TEXT [1F] ^
^PS(52.49,D0,311,D1,66)= (#66) TYPE OF SVC QUALIFIER [1F] ^
^PS(52.49,D0,311,D1,67)= (#67) TYPE OF SVC CODE [1F] ^
^PS(52.49,D0,311,D1,68)= (#68) TARGETED SERVICE FREE TEXT [1F] ^
^PS(52.49,D0,311,D1,69)= (#69) TARGETED SERVICE TEXT [1F] ^
^PS(52.49,D0,311,D1,71)= (#71) TARGETED SERVICE QUALIFIER [1F] ^
^PS(52.49,D0,311,D1,72)= (#72) TARGETED SERVICE CODE [1F] ^
^PS(52.49,D0,311,D1,73)= (#73) REASON FOR MTM FREE TEXT [1F] ^
^PS(52.49,D0,311,D1,74)= (#74) REASON FOR MTM TEXT [1F] ^
^PS(52.49,D0,311,D1,75)= (#75) REASON FOR MTM QUALIFIER [1F] ^
^PS(52.49,D0,311,D1,76)= (#76) REASON FOR MTM CODE [1F] ^
^PS(52.49,D0,311,D1,77)= (#77) TYPE OF SVC EXP DATE [1D] ^
^PS(52.49,D0,311,D1,78)= (#78) TYPE OF SVC EFF DATE [1D] ^
^PS(52.49,D0,311,D1,79)= (#79) TYPE OF SVC GROUP SETTING [1F] ^
^PS(52.49,D0,311,D1,81)= (#81) FINAL COMP PHARM DOSAGE FORM [1P:52.45] ^
^PS(52.49,D0,312)= (#312.1) SCRIPT VERSION NUMBER [1S] ^ (#312.2) REQUEST REFERENCE NUMBER [2F] ^ (#312.3) RETURN RECEIPT [3F] ^
^PS(52.49,D0,313)= (#313.1) ECL VERSION [1F] ^ (#313.2) DATA TYPE VERSION [2F] ^ (#313.3) STRUCTURES VERSION [3F] ^ (#313.4)
==>TRANSACTION DOMAIN [4F] ^ (#313.5) TRANSACTION VERSION [5F] ^ (#313.6) TRANSPORT VERSION [6F] ^
^PS(52.49,D0,314)= (#314.1) SENDER SOFTWARE DEVELOPER [1F] ^ (#314.2) SENDER SOFTWARE PRODUCT [2F] ^ (#314.3) SENDER SOFTWARE
==>VERSION REL [3F] ^
^PS(52.49,D0,315)= (#315.1) CHANGE MES REQ CODE [1P:52.45] ^
^PS(52.49,D0,316,0)=^52.49316^^ (#316) CHANGE MES SUB CODE
^PS(52.49,D0,316,D1,0)= (#.01) SEQUENCE [1N] ^
^PS(52.49,D0,316,D1,1)= (#1) SUB CODE [1P:52.45] ^
^PS(52.49,D0,317,0)=^52.49317^^ (#317) CHANGE REQUEST REASON TEXT
^PS(52.49,D0,317,D1,0)= (#.01) CHANGE REQUEST REASON TEXT [1W] ^
^PS(52.49,D0,318)= (#318.1) CH RES STATE LICENSE NUM [1F] ^ (#318.2) CH RES MEDICARE NUMBER [2F] ^ (#318.3) CH RES MEDICAID
==>NUMBER [3F] ^
^PS(52.49,D0,319)= (#319.1) CH RES UPIN [1F] ^ (#319.2) CH RES DEA NUMBER [2F] ^ (#319.3) CH RES HIN [3F] ^ (#319.4) CH RES
==>SOCIAL SECURITY NUMBER [4F] ^ (#319.5) CH RES NPI [5F] ^
^PS(52.49,D0,320)= (#320.1) CH REQ PROGRESS NOTE REF # [1N] ^ (#320.2) CH REQ PROGRESS NOTE COMMENT [2F] ^
^PS(52.49,D0,321)= (#321.1) CH RES CERT TO PRESCRIBE [1F] ^ (#321.2) CH RES DATA 2000 WAIVER ID [2F] ^ (#321.3) CH RES MUTUALLY
==>DEFINED [3F] ^
^PS(52.49,D0,322)= (#322.1) CH RES REMS PROVIDER ID [1F] ^ (#322.2) CH RES STATE SUBSTANCE NUMBER [2F] ^
^PS(52.49,D0,323)= (#323) CH RES SUPERVISOR [1P:52.45] ^
^PS(52.49,D0,324)= (#324) VAL CH RES DATE [1D] ^
^PS(52.49,D0,325)= (#325) CH RES SPECIALTY [1F] ^
^PS(52.49,D0,AUD,0)=^52.492D^^ (#20) AUDIT LOG
^PS(52.49,D0,AUD,D1,0)= (#.01) EDIT DATE/TIME [1D] ^ (#.02) FIELD NAME [2F] ^ (#.03) EDITED BY [3P:200] ^
^PS(52.49,D0,AUD,D1,VAL,0)=^52.492001^^ (#.04) NEW VALUE
^PS(52.49,D0,AUD,D1,VAL,D2,0)= (#.01) NEW VALUE [1W] ^
^PS(52.49,D0,CSSIG,0)=^52.499501^^ (#95.4) CS DIG SIGNATURE VALUE
^PS(52.49,D0,CSSIG,D1,0)= (#.01) CS DIG SIGNATURE VALUE [1W] ^
^PS(52.49,D0,INS)= (#27) VA PATIENT INSTRUCTIONS [1F] ^
^PS(52.49,D0,SIG,0)=^52.4926A^^ (#26) VA DISPENSING INSTRUCTIONS
^PS(52.49,D0,SIG,D1,0)= (#.01) VA DISPENSING INSTRUCTIONS [1F] ^
^PS(52.49,D0,X509DAT,0)=^52.499502^^ (#95.5) CS DIG SIGNATURE X509 DATA
^PS(52.49,D0,X509DAT,D1,0)= (#.01) CS DIG SIGNATURE X509 DATA [1W] ^
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):