UIH-010-2 UIH-010-3 UIH-010-6 UIB-070-1 Use the attribute qualifier of this field and only put the actual id in this element UIB-060-1 Use the attribute qualifier of this field and only put the actual id in this element UIB-030-1 UIB-030-2 UIB-080 UIB-100 UIH-020 Number assinged by Pharmacy System Trading Partner Defined UIB-030-3 UIH-030-1 Number assigned by Prescribing System UIB-070-2 Only values of D,P, ZZZ are supported by Surescripts UIB-060-3 or UIB-070-3 UIB-060-4 or UIB-070-4 Trading Partner Defined UIH-030-2 Initiator reference identifier This field may be used as a trace number between trading partners. UIH-030-3 Controlling Agency, Coded This field may be used as a trace number between trading partners. UIH-030-4 Responder control reference This field may be used as a trace number between trading partners. For RESUPP – In the LTC environment this is the prescription number assigned by the facility. UIH-010-4 REQ PVD-P2 Variance: In SCRIPT 10.6 this is optional. In SCRIPT 10.8 it is mandatory. PVD-PC PVD-SU PVD-SK PTT DRU-P COO REQ PVD-P2 PVD-PC PVD-SU PVD-SK PTT DRU-P DRU-D LastFillDate is Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network Variance: In SCRIPT 10.6 this is optional In SCRIPT 10.8 this is mandatory. COO REQ RES PVD-P2 Variance: In SCRIPT 10.6, this is optional. In SCRIPT 10.8, it is required. PVD-PC PVD-SU PVD-SK PTT DRU-P DRU-D LastFillDate is required when sending. Variance: In SCRIPT 10.6 this is optional In SCRIPT 10.8 it is required. REQ PVD-P2 PVD-PC PVD-SU PVD-SK PTT DRU-P DRU-R;At least one loop must contain 85 = Date Issued (Written Date) COO REQ RES PVD-P2 Variance: In SCRIPT 10.6 this is optional. In SCRIPT 10.8 it is mandatory. PVD-PC PVD-SU PVD-SK PTT DRU-P Variance: In SCRIPT 10.6 this is optional. In SCRIPT 10.8 the following rules apply. If an approved Prescription Change Response (DRU Ø1Ø-4343 Response Type, Coded value A (Approved) or C (Approved with changes)), one loop required for the drug prescribed. If a denied Prescription Change Response (DRU Ø1Ø-4343 Response Type, Coded value D (Denied)), the DRU Segment does not need to be sent, or if the DRU Segment is sent it must contain the prescribed loop from the Prescription Change Request that is being denied. REQ RES PVD-P2 PVD-PC PVD-SU PVD-SK PTT DRU-P; At least one loop must contain 85 = Date Issued (Written Date). Variance: In SCRIPT 10.6 this is optional In SCRIPT 10.8 either the Medication Prescriber or Dispensed is required using the following rules If RES segment Ø2Ø Code List Qualifier = “AH” (Dispensed) or “AJ” (Partially Dispensed), the DRU Segment (prescribed) may be sent as clarification. If RES segment Ø2Ø Code List Qualifier = “AK” (Not Dispensed), the DRU Segment (dispensed) or (prescribed) is required, depending upon what the pharmacy has knowledge of. DRU-D Variance: In SCRIPT 10.6 this is optional In SCRIPT 10.8 either the Medication Prescriber or Dispensed is required using the following rules. For Prescription Fill Status Notification Transactions - Partially Dispensed only, the quantity received is required by the prescriber. If RES segment Ø2Ø Code List Qualifier = “AH” (Dispensed) or “AJ” (Partially Dispensed), the DRU Segment (dispensed) is required. If RES segment Ø2Ø Code List Qualifier = “AK” (Not Dispensed), the DRU Segment (dispensed) or (prescribed) is required, depending upon what the pharmacy has knowledge of. STS-010 STS-010 STS Variance: In SCRIPT 10.6 a Verify could contain a provider, patient, and medication tag. In SCRIPT 10.8 these have been removed. STS-010 Variance: In SCRIPT 10.6 code 000 is allowed In SCRIPT 10.8 only code 010 is allowed REQ PVD-P2. Variance: In SCRIPT 10.6 this is optional. In SCRIPT 10.8 it is mandatory. PVD-PC PVD-SU PVD-SK PTT DRU-P REQ RES PVD-P2 PVD-PC PTT COO RES PVD-P2 PVD-PC PTT COO DRU-D DRU-P REQ PVD-PC PVD-SK PTT COO REQ PVD-P2 PVD-PC PVD-SU PVD-SK PTT DRU-P DRU-D COO used in CENSUS, NEWRX, CANRX REQ-010 REQ-020 REQ-030 REQ-010 REQ-020 REQ-030 REQ-020 REQ-030 Used in CANRX CANRES REQ-010 REQ-020 REQ-030 REQ-060 REQ-010 REQ-020 REQ-030 REQ-070 PVD-020 Used in RxFill PVD-020 PVD-020 On the mandatory transactions: One occurrence must contain the value “D3” (NCPDP Provider ID Number). One occurrence must contain the value “HPI” (National Provider ID). PVD-040 Value A PVD-080 Used in REFREQ, and RXFILL PVD-020 On the mandatory transactions: One occurrence must contain the value “D3” (NCPDP Provider ID Number). One occurrence must contain the value “HPI” (National Provider ID). PVD-040 Value A PVD-080 Used in NEWRX, RXCHG, CHGRES PVD-020 On the mandatory transactions: One occurrence must contain the value “D3” (NCPDP Provider ID Number). One occurrence must contain the value “HPI” (National Provider ID). PVD-040 Value A PVD-080 PVD-090 or PTT-070 Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network Used in NEWRX, RXCHG, CHGRES PVD-020 On the mandatory transactions: One occurrence must contain the value “D3” (NCPDP Provider ID Number). One occurrence must contain the value “HPI” (National Provider ID). PVD-040 Value A PVD-080 PVD-090 or PTT-070 Used in RXHREQ RXHRES PVD-020 On the mandatory transactions: One occurrence must contain the value “D3” (NCPDP Provider ID Number). One occurrence must contain the value “HPI” (National Provider ID). PVD-040 Value A PVD-070 PVD-080 D3 94 0B 1C 1D 1E 1G 1J 1M 2U ADI BO C1 EA EJ DH HI IP NC NF PD SY HPI G1 ZZ D3 94 0B 1C 1D 1E 1G 1J 1M 2U ADI BO C1 EA EJ DH HI IP NC NF PD SY HPI G1 ZZ D3 94 0B 1C 1D 1E 1G 1J 1M 2U ADI BO C1 EA EJ DH HI IP NC NF PD SY HPI G1 ZZ D3 94 0B 1C 1D 1E 1G 1J 1M 2U ADI BO C1 EA EJ DH HI IP NC NF PD SY HPI G1 ZZ Used in REFRES, RXCHG, CHGRES, CANRX, CANRES PVD-020 If the prescriber has an NPI, one occurrence must contain the value “HPI” (NPI). If the prescriber has a DEA number, one occurrence must contain the value “DH” (DEA Number). Not every entity allowed to prescribe may have an NPI or DEA. If this is the case, the other identifiers can be used. PVD-070 PVD-050 PVD-080 PVD-090 or PTT-070 Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network. PVD-100 Used in REFRES, RXCHG, CHGRES, CANRX, CANRES PVD-020 If the prescriber has an NPI, one occurrence must contain the value “HPI” (NPI). If the prescriber has a DEA number, one occurrence must contain the value “DH” (DEA Number). Not every entity allowed to prescribe may have an NPI or DEA. If this is the case, the other identifiers can be used. PVD-070 PVD-050 PVD-080 PVD-090 or PTT-070 PVD-100 Used in REFREQ PVD-020 If the prescriber has an NPI, one occurrence must contain the value “HPI” (NPI). If the prescriber has a DEA number, one occurrence must contain the value “DH” (DEA Number). Not every entity allowed to prescribe may have an NPI or DEA. If this is the case, the other identifiers can be used. PVD-070 PVD-050 Variance: In SCRIPT 10.6 this is optional. In SCRIPT 10.8 this is mandatory. PVD-080 PVD-090 or PTT-070 Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network PVD-100 Used in RXHREQ PVD-020 If the prescriber has an NPI, one occurrence must contain the value “HPI” (NPI). If the prescriber has a DEA number, one occurrence must contain the value “DH” (DEA Number). Not every entity allowed to prescribe may have an NPI or DEA. If this is the case, the other identifiers can be used. PVD-070 PVD-050 PVD-080 PVD-100 Used in RXHRES PVD-020 If the prescriber has an NPI, one occurrence must contain the value “HPI” (NPI). If the prescriber has a DEA number, one occurrence must contain the value “DH” (DEA Number). Not every entity allowed to prescribe may have an NPI or DEA. If this is the case, the other identifiers can be used. PVD-070 PVD-050 PVD-080 PVD-100 Used in NEWRX PVD-020 If the prescriber has an NPI, one occurrence must contain the value “HPI” (NPI). If the prescriber has a DEA number, one occurrence must contain the value “DH” (DEA Number). Not every entity allowed to prescribe may have an NPI or DEA. If this is the case, the other identifiers can be used. PVD-070 PVD-050 PVD-080 PVD-100 Used in RXFILL, CENSUS PVD-020 If the prescriber has an NPI, one occurrence must contain the value “HPI” (NPI). If the prescriber has a DEA number, one occurrence must contain the value “DH” (DEA Number). Not every entity allowed to prescribe may have an NPI or DEA. If this is the case, the other identifiers can be used. PVD-070 PVD-050 PVD-080 PVD-100 Used in REFRES, RXCHG, CHGRES, CANRX, CANRES PVD-020 If the prescriber has an NPI, one occurrence must contain the value “HPI” (NPI). If the prescriber has a DEA number, one occurrence must contain the value “DH” (DEA Number). Not every entity allowed to prescribe may have an NPI or DEA. If this is the case, the other identifiers can be used. Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network. PVD-050 PVD-070 PVD-080 PVD-090 or PTT-070 Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network. Used in CANRX PVD-020 If the prescriber has an NPI, one occurrence must contain the value “HPI” (NPI). If the prescriber has a DEA number, one occurrence must contain the value “DH” (DEA Number). Not every entity allowed to prescribe may have an NPI or DEA. If this is the case, the other identifiers can be used. Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network. PVD-050 PVD-070 PVD-080 PVD-090 or PTT-070 Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network. Used in NEWRX PVD-020 If the prescriber has an NPI, one occurrence must contain the value “HPI” (NPI). If the prescriber has a DEA number, one occurrence must contain the value “DH” (DEA Number). Not every entity allowed to prescribe may have an NPI or DEA. If this is the case, the other identifiers can be used. Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPTversions on the network PVD-050 PVD-070 PVD-080 Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network. PVD-090 or PTT-070 Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network. Used in REFREQ PVD-020 If the prescriber has an NPI, one occurrence must contain the value “HPI” (NPI). If the prescriber has a DEA number, one occurrence must contain the value “DH” (DEA Number). Not every entity allowed to prescribe may have an NPI or DEA. If this is the case, the other identifiers can be used. Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network. PVD-050 PVD-070 PVD-080 PVD-090 or PTT-070 Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network. Used in RXFILL, CENSUS PVD-020 If the prescriber has an NPI, one occurrence must contain the value “HPI” (NPI). If the prescriber has a DEA number, one occurrence must contain the value “DH” (DEA Number). Not every entity allowed to prescribe may have an NPI or DEA. If this is the case, the other identifiers can be used. PVD-050 PVD-070 PVD-080 PTT-050 PTT-030 PTT-010 PTT-050 PTT-030 PTT-010 PTT-050 PTT-030 COO-010 COO-020 COO-040 COO-050 COO-060 COO-090 COO-090 COO-130 COO-140 COO-010 COO-020 COO-040 COO-050 COO-060 COO-090 COO-090 COO-130 COO-140 COO-010 COO-020 COO-040 COO-050 COO-060 COO-010 COO-020 COO-040 COO-050 COO-060 COO-070 PVD-080 or PTT-060 or COO-080 COO-100 PVD-090 or PTT-070 or COO-150 DRU-030-2 and 3 DRU-080 DRU-030-2 and 3 DRU-060 DRU-060-1 DRU-060-2 This field is mandatory except when Quantity Qualifier = PRN. No quantity is required for PRN. If DRU Quantity Qualifier = PRN, This field must NOT be present. DRU-050 Variance: In SCRIPT 10.6, this is an..3. In SCRIPT 10.8, it is an1. NCPDP allows 0,1,2,3,4,5,7,8. Surescripts restricts to only 0 or 1. Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network DRU-080 DRU-030-2 and 3 DRU-060 Variance NCPDP is max 2 DRU-060-1 DRU-060-2 This field is mandatory except when Quantity Qualifier = PRN. No quantity is required for PRN. If DRU Quantity Qualifier = PRN, This field must NOT be present. DRU-050 Variance: In SCRIPT 10.6, this is an..3. In SCRIPT 10.8, it is an1. NCPDP allows 0,1,2,3,4,5,7,8. Surescripts restricts to only 0 or 1. Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network DRU-040 85 Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network DRU-080 DRU-030-2 and 3 DRU-060 DRU-060-1 DRU-060-2 This field is mandatory except when Quantity Qualifier = PRN. No quantity is required for PRN. If DRU Quantity Qualifier = PRN, This field must NOT be present. DRU-080 DRU-030-2 and 3 DRU-060 DRU-060-1 DRU-060-2 This field is mandatory except when Quantity Qualifier = PRN. No quantity is required for PRN. If DRU Quantity Qualifier = PRN, This field must NOT be present. DRU-080 DRU-030-2 and 3 DRU-060 DRU-060-1 DRU-060-2 This field is mandatory except when Quantity Qualifier = PRN. No quantity is required for PRN. If DRU Quantity Qualifier = PRN, This field must NOT be present. DRU-080 DRU-030-2 and 3 DRU-060 DRU-060-1 DRU-060-2 This field is mandatory except when Quantity Qualifier = PRN. No quantity is required for PRN. If DRU Quantity Qualifier = PRN, This field must NOT be present. DRU-050 Variance: In SCRIPT 10.6, this is an..3. In SCRIPT 10.8, it is an1. NCPDP allows 0,1,2,3,4,5,7,8. Surescripts restricts to only 0 or 1. Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network DRU-080 DRU-030-2 and 3 DRU-060 DRU-060-1 DRU-060-2 This field is mandatory except when Quantity Qualifier = PRN. No quantity is required for PRN. If DRU Quantity Qualifier = PRN, This field must NOT be present. DRU-050 Variance: In SCRIPT 10.6, this is an..3. In SCRIPT 10.8, it is an1. NCPDP allows 0,1,2,3,4,5,7,8. Surescripts restricts to only 0 or 1. Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network DRU-080 DRU-030-2 and 3 DRU-080 DRU-030-2 and 3 DRU-060 DRU-060-1 DRU-060-2 This field is mandatory except when Quantity Qualifier = PRN. No quantity is required for PRN. If DRU Quantity Qualifier = PRN, This field must NOT be present. DRU-080 DRU-030-2 and 3 DRU-060 DRU-060-1 DRU-060-2 This field is mandatory except when Quantity Qualifier = PRN. No quantity is required for PRN. If DRU Quantity Qualifier = PRN, This field must NOT be present. DRU-080 DRU-030-2 and 3 DRU-080 DRU-030-2 and 3 DRU-080 DRU-030-2 and 3 DRU-080 DRU-030-2 and 3 DRU-080 DRU-030-2 and 3 DRU-080 PVD-P2 PVD-PC DRU-110 SRC DRU-030-2 and 3 DRU-080 PVD-P2 PVD-PC SRC OBS-010 OBS-020 OBS-010-1 OBS-010-2 OBS-010-4 OBS-010-6 OBS-010-7 OBS-010-8 SIG-010 SIG-010-1 SIG-010-2 SIG-020 SIG-020-1 SIG-020-2 SIG-020-2 SIG-030 SIG-030-1 SIG-030-2 SIG-040 SIG-040-1 SIG-040-2 SIG-040-3 SIG-040-4 SIG-040-5 SIG-040-6 SIG-040-7 SIG-040-8 SIG-040-9 SIG-040-10 SIG-040-11 SIG-040-12 SIG-050 SIG-050-1 SIG-050-2 SIG-050-3 SIG-050-4 SIG-050-5 SIG-050-6 SIG-050-7 SIG-050-8 SIG-050-9 SIG-050-10 SIG-050-11 SIG-060 SIG-060-1 SIG-060-2 SIG-060-3 SIG-060-4 SIG-060-5 SIG-060-6 SIG-060-7 SIG-060-8 SIG-080 SIG-080-1 SIG-080-2 SIG-080-3 SIG-080-4 SIG-090 SIG-090-1 SIG-090-2 SIG-090-3 SIG-090-4 SIG-090-5 SIG-090-6 SIG-090-7 SIG-090-8 SIG-090-9 SIG-090-10 SIG-090-11 SIG-090-12 SIG-090-13 SIG-090-14 SIG-090-15 SIG--090-16 SIG-090-17 SIG-090-18 SIG-090-19 SIG-090-20 SIG--090-21 SIG-100 SIG-100-1 SIG-100-2 SIG-100-3 SIG-100-4 SIG-110 SIG-110-1 SIG-110-2 SIG-110-3 SIG-110-4 SIG-110-5 SIG-110-6 SIG-110-7 SIG-110-8 SIG-110-9 SIG-120 SIG-120-1 SIG-120-2 SIG-120-3 SIG-120-4 SIG-120-5 SIG-120-6 SIG-120-7 SIG-120-8 SIG-120-9 SIG-120-10 SIG-120-11 SIG-120-12 SIG-130 SIG-130-1 ALG-010-7999 If the sender sends “Y” (Yes), no other fields are sent in this segment. ALG-020-8000 ALG-030 07 ALG-030 36 ALG-040 Required if No Known Allergies = “N” (No), meaning allergies are known and will be reported. Value: LD ALG-040-03 ALG-050 ALG-050-03 Use UN for food allergies, ND,MF,RT,RX, UP for drug allegries ALG-060 Value: LD ALG-060-03 ALG-070 Value: LD ALG-070-03 DIA-010-8000 DIA-020 07 DIA-020 36 DIA-030 value LD DIA-030-03 DIA-040 DIA-040-03 PVD-070 DRU-120 DRU-130 DRU-140 DRU-150 DRU-160 PTT-080 PTT-040 PTT--020 Variance: In SCRIPT 10.6 this is optional. In SCRIPT 10.8 is it mandatory. STS-030 DRU-060 Variance NCPDP is maxoccurs 2 STS-020 DRU-110 DRU-050 Variance: In SCRIPT 10.6, this is an..3. In SCRIPT 10.8, it is an1. NCPDP allows 0,1,2,3,4,5,7,8. Surescripts restricts to only 0 or 1. DRU-070-1 DRU-070 DRU-020-1 DRU-080 DRU-010-2 or 10-12 DRU-010-3 to 9 DRU-020 Variance NCPDP max occurs is 2 DRU-100 OBS ALG DIA DRU-090 PTT-010 PVD-070 PVD-050 PVD-080 or PTT-060 PVD-090 or PTT-070 One Occurance Must Contain the Qualifier TE for Telephone ALG-0X0-02 DIA-0X0-02 ALG-0X0-01DIA-0X0-01 RES-010 RES-010 RES-010 RES-010 RES-010 DRU-010-3 DRU-010-4 DRU-010-6 DRU-010-8 DRU-010-9 DRU-010-13 DRU-010-14 DRU-010-15 DRU-010-16 DRU-010-17 DRU-020-02 Variance: In SCRIPT 10.6, the Quantity is an..35. In SCRIPT 10.8, it is n..10 XML adds one character for decimal place DRU-020-03 DRU-020-04 DRU-020-05 DRU-020-03 DRU-020-04 DRU-020-05 DRU-060-1 Variance: In SCRIPT 10.6, this is an..35. In SCRIPT 10.8, it is n..2. DRU-060-2 (8010) This field is mandatory except when Quantity Qualifier = PRN. No quantity is required for PRN. If DRU Quantity Qualifier = PRN, This field must NOT be present. DRU-060-1 DRU-060-2 DRU-070-5 DRU-070-4 DRU-070-3 DRU-070-2 DRU-080-2 DRU-080-1 DRU-100-1 DRU-100-2 DRU-100-3 DRU-100-4 and 5 DRU-100-6 DRU-100-07 DUE Acknowledgement Reason DRU-100-1 DRU-100-2 DRU-100-3 DRU-100-4 and 5 DRU-100-6 DRU-100-07 DUE Acknowledgement Reason DRU-100-4 DRU-100-5 DRU-100-4 DRU-100-5 Used in REFRES RES-010 RES-010 RES-010 RES-010 RES-020 RES-030, Not used in EDIFACT version RES-040 RES-020 RES-030, Not used in EDIFACT version RES-040 RES-020 RES-030 RES-040 RES-020 RES-030 RES-040 RES-020 AH RES-020 AJ RES-020 AK RES-030 RES-040 SRC-010 SRC-010-01 SRC-010-02 SRC-010-03 and 04 SRC-020 SRC-030 COO-030 PVD-040, Value "A" for the NUCC taxonomy list DRU-040 85 Required when sending 10.6; however, receivers of 10.6 messages cannot expect this information to always be present due to translation from lower SCRIPT versions on the network DRU-040 LD DRU-040 36 DRU-040 07 DRU-040 PE DRU-040 35 DRU-040 BE DRU-040 06 DRU-040 ZDS SIG SIG-070 SIG-070-1 SIG-070-2 SIG-070-3 SIG-070-4