info

Created By/On: Devel# 11/26/2015 | 5:23:47 AM

Maintained By/On: Jayden Smith 02/12/2018 | 5:06:479 AM

Controlled Substance Parameters by State - Layout

Controlled Substance Audit
Prescriber ID On Ctrl Sub
Missing Prescriber ID
Layout
Include Segment Description
AIR01 State Issuing Rx Serial Number
AIR02 State Issued Rx Serial Number
AIR03 Issuing Jurisdiction (of AIR05 ID)
AIR04 ID Qualifier of Person Dropping Off or Picking
AIR05 ID of Person Dropping Off or Picking Up Rx
AIR06 Relationship of Person Dropping Off or Picking
Include Segment Description
CDI01 Camp Drug Ingred. Seq. #
CDI02 Product ID Qualifier
CDI03 Product ID
CDI04 Camp Ingred QTY
CDI05 Camp Drug Doseage Units Cd
Include Segment Description
DSP01 Reporting Status
DSP02 Rx #
DSP03 Date Written
DSP04 Refills Auth
DSP05 Dispensed Date
DSP06 Refill #
DSP07 Product ID Qualifier
DSP08 Send Compound NDC
DSP09 QTY Dispensed
Include Segment Description
TH01 Version / Release Number
TH02 Transaction Control Number
TH03 Transaction Type
TH04 Response ID
TH05 Creation Date (Required)
TH06 Creation Time (Required)
Include Segment Description
ID01 Unique Information Source ID
ID02 Information Source Entity Name
ID03 Message
Include Segment Description
PAT01 ID Qualifier of Pt ID
PAT02 ID Qualifier
PAT03 Patient ID
PAT04 ID Qualifier of Additional Patient Identifier
PAT05 Additional Patient ID Qualifier
PAT06 Additional ID
PAT07 Patient Last Name
PAT08 Patient First Name
Include Segment Description
PHA01 Pharmacy NPI
PHA02 NCPDP/NABP Provider ID
PHA03 Pharmacy DEA
PHA04 Pharmacy Name
PHA05 Pharmacy Addr 1
PHA06 Pharmacy Addr 2
Include Segment Description
PRE01 Prescriber NPI
PRE02 Prescriber DEA
PRE03 DEA # Suffix
PRE04 Prescriber St License
PRE05 Prescriber Last Name
PRE06 Prescriber First Name
Layout File Options
Layout