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Medication

#MN        Name of Medication

#RF        Refill Information

#IN        Instructions  (This will pull the information that is in the SIG line)

#DW        "Dispense as Written must be written in ink"

#DI        "Dispense as Written"

#DQ        Dispense Quantity (numeric)

#TQ        Dispense Quantity (alpha)

#DU        Dispense Unit

#PRB        Associated Diagnosis (code and description)

#PDC        Disclaimer for fax table.  "Valid only if transmitted by facsimile machine."

#FM        "This prescription has been electronically transmitted via facsimile to:"

#NTP        Note to Pharmacy

#SL        Signature Line on printed Rx or "Electronically Signed" on Faxed Rx  (This will add an actual signature line for the provider to sign)

#SUDAY        Days Supply

 

Pharmacy

#PN        Pharmacy name

#PA1        Address Line 1

#PA2        Address Line 2

#PC        Pharmacy City

#PST        Pharmacy State

#PZ        Pharmacy Zip

#BY        Pulls the word "by"

#PE        Sending Employee/Physician   

 

Patient Information

#NU        Account number

#NA        Patient name

#MR        Med Rec number

#SN        Second name

#AG        Age

#SX        Sex

#BD        DOB

#PH        Home Phone

#BP        Business Phone

#A1        Address 1

#A2        Address 2

#CI        City (/usr3/f)

#CU        City

#ST        State

#SA        ST (/usr3/f)

#ZI        Zip code

 

Guarantor Information

#GN        Name

#G1        Address 1

#G2        Address 2

#GC        City

#GS        State

#GZ        Zip code

#EM        Employer

 

Practice Information

#CN        Name

#C1        Address

#C2        Address2

#CC        City

#CS        State

#CZ        Zip

#CP        Phone

 

Prescribing Physician Information

#DR        Name

#PRCR        Prescriber Credentials

#PRA1        Prescriber Address

#PRA2        Prescriber Address 2

#PRCI        Prescriber City

#PRS        Prescriber State

#PRZ        Prescriber Zip Code

#PRP        Prescriber Phone Number

#DN        Provider Number

#DS        SSN (only transmitted if no DEA Number is available for the ordering of Controlled Substances)

#DEA        DEA Number

#FDEA        DEA Number with Suffix

#CTP        State ID (DPS) WR#1108231616

#DX        Tax ID or License#

#NPI        NPI Number

 

Supervising Physician

#SUN        Supervisor Name

#SUA1        Supervisor Address

#SUA2        Supervisor Address 2

#SUC        Supervisor City

#SUS        Supervisor State

#SUZ        Supervisor Zip Code

#SUP        Supervisor Phone Number

 

Referring Physician Info

#RP        Name

#RA        ABBRNAME

#R1        Address 1

#R2        Address 2

#RC        City

#RS        State

#RZ        Zip

 

General Information

#DA        System Date

#DT        System Date-Full

#TM        Time

#FT        Encounter #

#IN        Comment (Appts)