| Field Name |
Definition |
Values |
R/O*
|
Field
Format
|
Field
Length
|
Positions |
| Identifier |
|
|
O
|
A/N
|
3
|
001-003 |
| BIN |
|
|
O
|
N
|
6
|
004-009 |
| Version Number |
|
|
O
|
N
|
2
|
010-011 |
| Transaction Code |
|
|
O
|
N
|
2
|
012-013 |
| NCPDP or DEA License Number |
Pharmacies report the NCPDP number. Dispensing practitioners use the DEA License # |
|
R
|
A/N
|
12
|
014-025 |
| Customer ID Number |
Customer ID (Driver License, State ID, Military ID, Passport) |
|
R
|
A/N
|
20
|
026-045 |
| Zip Code |
3 digit US Postal Code identifying the state code |
|
O
|
A/N
|
3
|
046-048 |
| Birth Date |
Customer's birth date |
YYYYMMDD |
R
|
N
|
8
|
049-056 |
| Sex Code |
Sex / Gender of the patient |
1=Male
2=Female
3=Animal |
O
|
N
|
1
|
057-057 |
| Date Filled |
Date the prescription was filled |
YYYYMMDD |
R
|
N
|
8
|
058-065 |
| Rx # |
Prescription number assigned by the pharmacy |
|
R
|
A/N
|
7
|
066-072 |
| New-Refill Code |
Code indicating whether the prescription is new or refill |
|
O
|
N
|
2
|
073-074 |
| Metric Quantity |
Number of metric units of drug being dispensed |
|
R
|
N
|
5
|
075-079 |
| Days Supply |
Estimated number of days the prescription will last |
|
O
|
N
|
3
|
080-082 |
| Compound Code |
Code indicating whether or not the prescription is a
compound medication
|
|
O
|
N
|
1
|
083-083 |
| NDC Number |
National Drug Code of the drug dispensed |
(5-4-2) format |
R
|
A/N
|
11
|
084-094 |
| Prescriber ID |
DEA # of the prescribing physician |
|
R
|
A/N
|
10
|
095-104 |
| DEA Suffix |
DEA Suffix |
|
O
|
A/N
|
4
|
105-108 |
| Date Rx Written |
Date the Rx was written |
YYYYMMDD |
O
|
N
|
8
|
109-116 |
| Number of Refills Authorized |
Number of refills authorized by Prescriber |
|
O
|
N
|
2
|
117-118 |
| Rx Origin Code |
Code indicating the origin of the prescription |
|
O
|
A/N
|
1
|
119-119 |
| Customer Location |
Code indicating location of patient (customer) |
|
O
|
A/N
|
2
|
120-121 |
| Diagnosis Code |
ICD-9 or CPT code provided by Prescriber |
|
O
|
A/N
|
7
|
122-128 |
| Alternate Prescriber |
State license number or HIN. To be included if DEA number field is for an institution rather than the prescriber. |
|
O
|
A/N
|
10
|
129-138 |
| Patient Last Name |
Patient Last Name |
|
R
|
A/N
|
15
|
139-153 |
| Patient First Name |
Includes middle initial and suffix |
|
R
|
A/N
|
15
|
154-168 |
| Patient Address |
Street or PO Box # |
|
R
|
A/N
|
30
|
169-198 |
| Patient State |
Standard 2-digit State abbreviation (example: OK). |
|
R
|
A/N
|
2
|
199-200 |
| Patient Zip Code |
Full zip code (including 4-digit suffix if available). |
|
R
|
A/N
|
9
|
201-209 |
| Triplicate Serial # |
# Assigned to triplicate Rx document by States with
triplicate programs.
|
|
O
|
A/N
|
12
|
210-221 |
| Filler |
Filler |
|
O
|
A/N
|
1
|
222 |
|
*R = required O = optional A/N = Alphabet/Numeric
NOTE:
1. Fixed length ASCII text files with one record (line) per prescription.
2. Carriage return at the end of each record.
|
