Transcription
Illinois Prescription Monitoring ProgramAutomated Connection GuidePrescription Monitoring Program (PMP) Medication HistoryRevised: 03/25/2016Version 1.0
Document NameIllinois PMP Automated Connection Guide –PMP Medication HistoryTable of Contents1. DOCUMENT CHANGE HISTORY . 32. INTRODUCTION . 33. PROCESS FLOW . 54. FILE NAMING CONVENTIONS. 85. TRANSACTION STRUCTURE . 86. TRANSACTION SAMPLES . 267. ACKNOWLEDGEMENT AND ERROR HANDLING PROCESSES . 35Last Updated: 03/25/2016 version 0.03Page - 2 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication History1. DOCUMENT CHANGE HISTORYVersion0.010.02DOCUMENT NAME: Canonical Guide Issue DateModified ByComments/Reason03/17/2016 Craig BerberetFirst draft of Automated Connection Guide03/22/2016 Stanley MurzynskiUpdated Process Flow, Transaction Structure,Transaction Samples, Error Handling0.033/25/2016Craig BerberetHeaders and Footers, Table of Contents,Introduction2. INTRODUCTION2.1. OverviewThe Illinois Department of Human Services (DHS) operates an electronic tool that collects informationon dispensed medications, known as the Prescription Monitoring Program or PMP. That electronictool represents a medication history of controlled substance prescriptions (Schedule II - V) dispensedby licensed pharmacies or dispensed from licensed practitioners under Illinois State law. Access tothat data is provided via the Automated Connection to Eligible Hospitals and Eligible Professionalsmaking a secure query from a Certified Electronic Health Record Technology or health informationsystem.The response provided from the PMP database via the Automated Connection is a real-timetransaction based on the authentication of the requestor and a match of the patient recordrequested. The request and response utilize the NCPDP Script standard or the SOAP standard forLast Updated: 03/25/2016 version 0.03Page - 3 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication Historymedication history.The S&I Framework PDMP & Health IT Integration workgroup is currently accepting comments andinput on the national standard for interoperability for the PDMP transaction. The NCPDP RxHistory isone of several standards that has been discussed and is being considered. Once the S&I Frameworkworkgroup establishes a final standard, this transaction may be adjusted to comply with the standardand potentially offered as a web service for consumption directly from a standards-compliantrequesting system. In the event the transaction changes, this document will be updated to reflect thechanges and shared with all current trading partners interested in the Prescription MonitoringProgram Automated Connection.2.2. ScopeThis Automated Connection Guide defines the query/response transactions for Medication Historyto/from the Illinois PMP. The initial scope of this transaction is for licensed healthcare providersauthorized by statute, accessing patient medication history from the Illinois PMP only. This guide isunique to Illinois Prescription Monitoring Program.2.3. Terms and AcronymsTerm/AcronymNCPDPPMIXPMPSCRIPTLast Updated: 03/25/2016 version 0.03DescriptionNational Council for Prescription Drug Programs - a not-forprofit, ANSI-accredited, standards development organizationPrescription Monitoring Information Exchange Architecture –enabling interstate exchange of PMP dataPrescription Monitoring ProgramThe NCPDP standard used for medication history queries andresponsesPage - 4 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication History3. PROCESS FLOW3.1. High Level Process – Process flow OverviewHIS-NCPDP MethodNCPDP Request / ResponseNCPDPTransformerPMIXPMP ServiceHIS-PMIX Method PMIX Request / ResponseThe PMP Service receives requests both in PMIX and NCPDP formats.The NCPDP Transformer converts the messages from NCPDP to PMIX and backPMP Service is secured by SSL and username based authenticationAuthentication is performed at PDMP service levelThe username is validated against the Facility the user is registered withLast Updated: 03/25/2016 version 0.03Page - 5 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication History3.2. High Level Process – Query from a Health Care Institution Partner VIA ADT Message (example: AndersonHospital)4EmergencyPDFDoctor Office1PDFHL72PMP izedResponse1. HL7 ADT messages are sent from various departments from an Health care institution2. PMP Requestor – is a component which receives HL7 messages, generates PMIXRequests and send it to PMP Server. It Can also convert the PMIX Response to a PDFviewable by the department3. PMIX Request / Response is the xml structure understood by PDMP Server4. PMP Server – receives PMIX queries and returns medication history dataLast Updated: 03/25/2016 version 0.03Page - 6 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication History3.3. High Level Process – Query from a Health Care Institution Partner VIA NCPDP Connection (example: EPIC)NCPDP2 Transformer14 PMP ServerAuthenticate &Validate UserHCIEmergencyDoctor ConsultationsPharmacyFIRENCPDP Request /Response3Transform NCPDP to PMIXTransform PMIX to NCPDPPMIX Request Response1. HL7 ADT messages are sent from various departments from an Health care institution2. NCPDP Transformer – Transforms NCPDP requests and converts to PMIX and back.3. PMIX Request / Response is the xml structure understood by PDMP Server4. PDMP Server – receives PMIX queries and returns medication history dataLast Updated: 03/25/2016 version 0.03Page - 7 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication History4. FILE NAMING CONVENTIONS4.1. Special Naming ConventionThere are no special or unique file naming conventions associated with the medication historyrequests that are required for appropriate message handling.Whatever naming convention is used by the request submitter will be seen in the response, precededby “PMP”.5. TRANSACTION STRUCTURE5.1. NCPDP XML Transaction StructureThe NCPDP SCRIPT standard version 2031.012 is the initial required format. The requestor will supply theNCPDP Transport wrapper according to standard as well as the populated query. The response will beformatted to reflect the NCPDP transport wrapper and standard response formatLast Updated: 03/25/2016 version 0.03Page - 8 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication History5.1.1. Transaction Representation5.1.1.1.In the table below, the NCPDP Script Medication History Request and Response are represented.Data elementDescription/Business LogicReq ROpt OCond CXMLd lStandard XML declaration.R ?xml version "1.0" encoding "UTF-8"? XMLXMLdeclarationStandard XML declaration.R ?xml version "1.0" encoding "UTF-8"? XML elementn/a/MessageWrapper for the entiremessage. Includes XMLnamespace declarations.R Message xmlns "http://www.ncpdp.org/schema/SCRIPT"release "006" version "010"XML elementn/aR Header / Header Text64R From Qualifier "ZZZ" EPIC /From Text64R MessageID 213416 /MessageID Text35R SentTime2015-08-21T18:13:58.0Z /SentTime DateTime19XML elementData Hea Wrapper for the transportderheader.Indicates the sender of themessage. Should be “EPIC”for EPIC systems.Must/Message/Hea contain a Qualifier attribute:der/FromZZZ - Mutually definedA unique reference identifierfor the transmission,generated from the sender of/Message/Hea the request and the sender ofthe response. Echoed back inder/MessageIDthe response.The time and date of the/Message/Hea transmission. In the formatder/Sent time CCYY-MM-DDThh:mm:ss.ZLast Updated: 03/25/2016 version 0.03P a g e - 11 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication HistoryReq RData element Description/Business LogicOpt OCond CXML elementData TypeFieldSize/Message/Header/Security/UsernameTok User name. Not used byen/Username PDMP.O Username /Username Text35/Message/Header/Security/S Wrapper for sender’s Tertiaryenderidentification.R Sender /Sender XML elementn/aTertiaryIdentificationR TertiaryIdentification 1150057572 /TertiaryIdentification Text35R Receiver /Receiver Text35Used as the Facility ID of thesender or receiver/Message/Header/Security/R Wrapper for Receiver’seceiverTertiary identificationData elementDescription/Business LogicReq ROpt OCond CXML elementData ��s NPI entification/MutuallyDefinedShould be EPICLast Updated: 03/25/2016 version 0.03R NPI 1000001895 /NPI Text12R MutuallyDefined EPIC /MutuallyDefined Text10P a g e - 12 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication HistoryReq ROpt OData elementDescription/Business LogicXML elementCond ityPrescriber’s speciality codeR Specialty 207R00000X /Specialty me Clinic name of the prescriber R ClinicName TES DEPARTMENT FOR WI /ClinicName /Message/Body/RxHistoryRequest/Prescrib Firstname and Lastname ofer/Namethe r/AddressAddress of the r/Communic Contact numbers of theationNumbers prescriberLast Updated: 03/25/2016 version 0.03Data TypeFieldSizeText35Text64XML Elementn/aR PlaceLocationQualifier AD2 /PlaceLocationQualifier /Address XMLElementn/aR CommunicationNumbers Communication Number 4198553055 /Number Qualifier TE /Qualifier /Communication /CommunicationNumbers XML Elementn/aR Name LastName Stolldorf /LastName FirstName Tim /FirstName /Name Address AddressLine1 555 Epic Way /AddressLine1 AddressLine2 Building 101 /AddressLine2 City MADISON /City State WI /State ZipCode 53717 /ZipCode P a g e - 13 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication HistoryReq ROpt OData elementDescription/Business LogicCond C/Message/Body/RxHistoryRequest/Patient/ Firstname and Lastname ofNamethe erGender of the OfBirthPatient’s Date of sPatient’s ient/BenefitsCoordination/EffectiveDatePatient’s contact numbersThe effective date fromwhich patient’s consent isvalid forLast Updated: 03/25/2016 version 0.03XML elementData TypeFieldSizeR Name LastName Paltrow /LastName FirstName Mary /FirstName /Name XML Elementn/aR Gender F /Gender Text1R DateOfBirth Date 1951-06-18 /Date /DateOfBirth XML Elementn/aR Address AddressLine1 2645 Mulberry Lane /AddressLine1 City Toledo /City State OH /State ZipCode 43605 /ZipCode /Address XMLElement40R CommunicationNumbers Communication Number 4198553055 /Number Qualifier TE /Qualifier /Communication /CommunicationNumbers XML Element40R EffectiveDate Date 2014-08-22 /Date /EffectiveDate XML Element35P a g e - 14 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication HistoryReq ROpt OData elementDescription/Business LogicXML elementCond ord ExpirationDate ination/Expira The date when patient’s Date 2015-08-21 /Date tionDateconsent expiresR /ExpirationDate Y - Patient gave consent forprescriber to receive themedication history from anyprescriber. N - Patientconsent not given. P - Patientgave consent for prescriberto only receive themedication history thisprescriber prescribed. X Parental/Guardian consenton behalf of a minor forprescriber to receive themedication history from any/Message/Bod prescriber. Z y/RxHistoryRe Parental/Guardian consentquest/Patient/ on behalf of a minor forBenefitsCoord prescriber to only receive theination/Conse medication history thisntprescriber prescribed.R Consent Y /Consent Last Updated: 03/25/2016 version 0.03Data TypeFieldSizeXML Element2Text9P a g e - 15 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication andard XML declaration.RData elementDescription/Business LogicReq ROpt OCond CXML element/MessageWrapper for the entiremessage. Includes XMLnamespace declarations.R Message xmlns "http://www.ncpdp.org/schema/SCRIPT"release "006" version "010"XML Elementn/a/Message/HeaderWrapper for the transportheader.R Header / Header XML elementn/a/Message/Header/ToIndicates the intendedmessage recipient. Must be:EPIC for EPIC systems Mustcontain a Qualifier attribute:ZZZ - Mutually definedR To Qualifier "ZZZ" EPIC /To Text35/Message/Header/FromIndicates the sender of themessage. Must contain aQualifier attribute: ZZZ Mutually definedR From Qualifier "ZZZ" PDMP /From Text35/Message/Header/MessageIDA unique reference identifierfor the transmission,generated from the sender ofthe request and the senderof the response. Echoed backin the response.R MessageID 213416 /MessageID Text35Last Updated: 03/25/2016 version 0.03 ?xml version "1.0" encoding "UTF-8"? XML declarationn/aData TypeFieldSizeP a g e - 16 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication HistoryData elementDescription/Business LogicReq ROpt OCond C/Message/Header/RelatesToMessageIDMessage ID of the request forwhich this Responsecorresponds toR RelatesToMessageID 213416 /RelatesToMessageID Text35/Message/Header/Sent timeThe time and date of thetransmission. In the formatCCYY-MM-DDThh:mm:ss.ZR SentTime2015-08-21T18:13:58.0Z /SentTime an contain either Approved or Denied indicating approval or denialR Approved/ or /Denied XML Elementn/aDescription/Business LogicReq ROpt OCond CXML elementData TypeFieldSizeR Name LastName Paltrow /LastName FirstName Mary /FirstName /Name XML Elementn/aR DateOfBirth Date 1951-06-18 /Date /DateOfBirth XML Elementn/aR Address AddressLine1 2645 Mulberry Lane /AddressLine1 City Toledo /City State OH /State ZipCode 43605 /ZipCode /Address XMLElementn/aXML elementData TypeFieldSizeNCPDPResponseBodyData element/Message/Body/RxHistoryResponse/Patien Firstname and Lastname oft/Namethe eOfBirthPatient’s Date of ssPatient’s AddressLast Updated: 03/25/2016 version 0.03P a g e - 17 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication HistoryReq ROpt OData element Description/Business LogicCond CXML fitsCoord The effective date from EffectiveDate ination/Effecti which patient’s consent is Date 2014-08-22 /Date veDatevalid forR /EffectiveDate rdination/Expira The date when patient’stionDateconsent expiresY - Patient gave consent forprescriber to receive themedication history from anyprescriber. N - Patientconsent not given. P - Patientgave consent for prescriberto only receive themedication history thisprescriber prescribed. X Parental/Guardian consenton behalf of a minor forprescriber to receive themedication history from any/Message/Bod prescriber. Z y/RxHistoryRe Parental/Guardian consentquest/Patient/ on behalf of a minor forBenefitsCoord prescriber to only receive theination/Conse medication history thisntprescriber prescribed./Message/Body/RxHistoryRequest/Patient/ Wrapper for containing theMedicationDis information aboutpensedMedication HistoryLast Updated: 03/25/2016 version 0.03Data TypeFieldSizeXML Elementn/aR ExpirationDate Date 2015-08-21 /Date /ExpirationDate XML Element2R Consent Y /Consent Textn/aR MedicationDispensed /MedicationDispensed XML Element64P a g e - 18 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication cationDispensed/DrugD Description of the prescribed DrugDescription HYDROCODON-ACETAMINOPHEN 5escriptiondrugR500 /DrugDescription ispensed/DrugCoded/Product Product code of theCodeprescribed drugR ProductCode 00406035705 /ProductCode /Message/Bod Qualifier of the prescribedy/RxHistoryRe drugR ProductCodeQualifier ND /ProductCodeQualifier nDispensed/DrugCoded/Strength The strength of the drugR Strength 5 MG-500MG /Strength ispensed/Quant The quantity of the drugity/ValueprescribedR Value 30 /Value /Message/Body/RxHistoryRe CodeListQualifier of the drug R CodeListQualifier 87 /CodeListQualifier nDispensed/Quantity/UnitSource Unit Source Code for theCodecode list qualifierR UnitSourceCode AC /UnitSourceCode /Message/Bod PotencyUnitCode for they/RxHistoryRe drugR PotencyUnitCode C38046 /PotencyUnitCode ///Message/Bod No. of days the drugsy/RxHistoryRe prescribed will lastR DaysSupply 30 /DaysSupply Last Updated: 03/25/2016 version umber5P a g e - 19 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication Dis Any notes regarding thepensed/Notemedication dispensedR Note /Note ispensed/Refills/QualifierQualifier for the refills valueR Qualifier R /Qualifier ispensed/Refills/ValueRefills valueR Value 3 /Value is WrittenDate pensed/Writt Date when the prescription Date 2015-06-30 /Date enDate/Datewas writtenR /WrittenDate ispensed/LastFil Date when the drug was lastlDate/DatefilledLast Updated: 03/25/2016 version 0.03R LastFillDate Date 2015-06-30 /Date /LastFillDate Textn/aText2Text5Date19Date19P a g e - 20 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication HistoryReq ROpt OData element Description/Business LogicCond CXML element Pharmacy StoreName ACME INC /StoreName Address AddressLine1 391 Industry Drive, SUITE300 /AddressLine1 /Message/Bod City AUBURN /City y/RxHistoryRe State AL /State quest/Patient/ ZipCode 36832 /ZipCode MedicationDis /Address pensed/PharDetails of the pharmacy themacydrug was given fromR /Pharmacy ispensed/Prescr First name and last name ofiber/Namethe edicationDispensed/Prescriber/AddressAddress of the edicationDis The source from where thepensed/Histor medication history wasySourceobtained fromLast Updated: 03/25/2016 version 0.03Data TypeFieldSizeXML Elementn/aR Name LastName PRESCRIBER /LastName FirstName/ /Name XML Elementn/aR Address AddressLine1 1265 Lombardi Ave /AddressLine1 City GREEN BAY /City State WI /State ZipCode 54304 /ZipCode /Address XML Elementn/aR HistorySource SourceReference 147803-0001 /SourceReference FillNumber 0 /FillNumber /HistorySource XML Elementn/aP a g e - 21 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication History5.1.2. PMIX base XMLTransaction Representation5.1.2.1.In the table below, the PMIX based xml History Request and Response are represented. The SOAP Header and Bodyelements are not described here.PMIXResponseTransportLayerReq ROpt OCond CXML elementRNamespace is fromxmlns:req "http://xml.netbeans.org/schema/RequestPatientXML Elementn/aR req:FacilityId RVC /req:FacilityId Text15Patient’s given nameR req:PatientGivenName Bilbo /req:PatientGivenName Text50Patient’s surnamePatient’s date of birth inYYYY-MM-DD formatR req:PatientSurName Baggins /req:PatientSurName Text50Rreq:DateOfBirth 1959-12-26 /req:DateOfBirth Date19Data elementDescription/Business NameRequestPatient/DateOfBirthWrapper for the entire XMLRequestFacility ID from where therequest is being sentData TypeFieldSizePMIXResponseTransportLayerReq ROpt OCond CXML elementData TypeFieldSizePrescriptionRe Wrapper for the entire XMLportResponseRNamespace is fromxmlns:ns2 ”XML Elementn/aPrescriptionRe Facility Id from there theport/FacilityId request is coming fromR ns2:FacilityId RVC /ns2:FacilityId Text15Data elementDescription/Business LogicLast Updated: 03/25/2016 version 0.03P a g e - 22 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication HistoryReq ROpt OData element Description/Business LogicCond CXML elementPrescriptionRe Date when the report isport/ReportEx executed in YYYY-MM-DD ns2:ReportExecutionDate 2015-04ecutionDateformatR23 /ns2:ReportExecutionDate PrescriptionRe Time when the report isport/ReportEx executed in HH:mm:ss ns2:ReportExecutionTime 02:37:41 /ns2:ReportExecutioecutionTimeformatRnTime PrescriptionReport/Prescripti Wrapper for one of theonprescription detailsR ns2:Prescription /ns2:Prescription ns2:Organization ns2:OrganizationName DRUGS RUS /ns2:OrganizationName ns2:Address ns2:Street 12 PicadillySquare /ns2:Street ns2:City London /ns2:City ns2:State IL /ns2:State ns2:PostalCode 65555 /ns2:PostalCodPrescriptionRee ns2:ContactInformation 773-333port/Prescripit5555 /ns2:ContactInformation /ns2:Address /ns2:Orgon/Organizati Wrapper for the organizationondetails of the pharmacyRanization PrescriptionRe Wrapper for the patientport/Prescripit details for whom theon/Patientmedication is prescribed toR ns2:Patient ns2:GivenName SHERLOCK /ns2:GivenName ns2:SurName HOLMES /ns2:SurName ns2:BirthDate 1954-16 /ns2:BirthDate ns2:SexCode M /ns2:SexCode ns2:Address ns2:Street 121 BABRBERSTREET /ns2:Street ns2:City YORKSHIRE /ns2:City ns2:State IL /ns2:State ns2:PostalCode 62690 /ns2:PostalCode /ns2:Address /ns2:Patient Date19Time19XML Elementn/aXML Elementn/aXML Elementn/aXML Elementn/aXML Elementn/a ns2:Prescriber ns2:GivenName DrMoriarty /ns2:GivenName ns2:Address ns2:City chicPrescriptionReport/Prescripti Wrapper for the Prescriber’son/Prescriber detailsRago /ns2:City ns2:State IL /ns2:State ns2:PostalCode 62544 /ns2:PostalCode /ns2:Address /ns2:Prescriber PrescriptionReport/Prescription/Prescriptio Wrapper fornDrugPrescriptionDrug informationR ns2:PrescriptionDrug /ns2:PrescriptionDrug Last Updated: 03/25/2016 version 0.03Data TypeFieldSizeP a g e - 23 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication HistoryReq ROpt OData element Description/Business LogicCond CXML nDrug/NDCNumberNDC Number of the drugR ns2:NDCNumber 54092037701 /ns2:NDCNumber abelNameLabel Name of the drugR ns2:LabelName ADDERALL /ns2:LabelName rugStrengthStrength of the drugR ns2:DrugStrength 30 MG /ns2:DrugStrength PrescriptionReport/Prescription/Prescriptio ns2:DrugUnitOfMeasure TABLET /ns2:DrugUnitOfnDrug/DrugU Measurement unit of theMeasure nitOfMeasure rug/ScheduleSchedule of the drugPrescriptionReport/Prescription/Prescriptio Unique number to identifynNumberthe prescriptionPrescriptionReport/Prescripti Date when the prescriptionon/Prescriptio was filled in YYYY-MM-DDnFilledDateformatLast Updated: 03/25/2016 version 0.03Data TypeFieldSizeText56Text56Text35Text35Text2R ns2:Schedule 2 /ns2:Schedule R ns2:PrescriptionNumber 999999997 /ns2:PrescriptionNumber Number35R ns2:PrescriptionFilledDate 2014-55 /ns2:PrescriptionFilledDate 19DateP a g e - 24 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication HistoryReq ROpt OData element Description/Business LogicCond CXML tCodePrescriptionReport/Prescription/PaymentData TypeFieldSizeDate when the prescriptionwas written in YYYY-MM-DDformatR ns2:PrescriptionWrittenDate 2014-324 /ns2:PrescriptionWrittenDate Date19Number of refills authorisedR ns2:RefillsAuthorizedCount 1 /ns2:RefillsAuthorizedCount Number5Dispensed quantity of thedrugR ns2:DispensedQuantity 30 /ns2:DispensedQuantity Number5Supplies countRns2:DaysSupplyCount 30 /ns2:DaysSupplyCount Number5Payment codeR ns2:PaymentCode 04 /ns2:PaymentCode Number2R ns2:Payment CommericalInsurance /ns2:Payment Text35Name of the paymentLast Updated: 03/25/2016 version 0.03P a g e - 25 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication History6. TRANSACTION SAMPLES6.1. NCPDP XML6.1.1. Request ?xml version "1.0"? Message version "010" release "006" xmlns "http://www.ncpdp.org/schema/SCRIPT" Header To Qualifier "ZZZ" PDMP /To From Qualifier "D" EPIC /From MessageID 213416 /MessageID SentTime 2015-08-21T18:13:58.0Z /SentTime Security UsernameToken Username 2104 /Username /UsernameToken Sender TertiaryIdentification RVC /TertiaryIdentification /Sender Receiver TertiaryIdentification PMPGATEWAY /TertiaryIdentification /Receiver /Security TestMessage 1 /TestMessage TertiaryIdentifier FIL /TertiaryIdentifier /Header Body RxHistoryRequest Prescriber Identification DEANumber BA2397443 /DEANumber NPI 1000001895 /NPI MutuallyDefined EPIC /MutuallyDefined /Identification Specialty 207R00000X /Specialty ClinicName TES DEPARTMENT FOR WI /ClinicName Name LastName Stolldorf /LastName FirstName Tim /FirstName /Name Address AddressLine1 555 Epic Way /AddressLine1 AddressLine2 Building 101 /AddressLine2 City MADISON /City State WI /State ZipCode 53717 /ZipCode PlaceLocationQualifier AD2 /PlaceLocationQualifier /Address CommunicationNumbers Communication Last Updated: 03/25/2016 version 0.03P a g e - 26 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication History Number 6082719100 /Number Qualifier TE /Qualifier /Communication Communication Number 6082719101 /Number Qualifier FX /Qualifier /Communication /CommunicationNumbers /Prescriber Patient Name LastName Baggins /LastName FirstName Bilbo /FirstName /Name Gender M /Gender DateOfBirth Date 1959-12-26 /Date /DateOfBirth Address AddressLine1 2645 Mulberry Lane /AddressLine1 City Toledo /City State OH /State ZipCode 43605 /ZipCode /Address CommunicationNumbers Communication Number 4198553055 /Number Qualifier TE /Qualifier /Communication /CommunicationNumbers /Patient BenefitsCoordination EffectiveDate Date 2014-08-22 /Date /EffectiveDate ExpirationDate Date 2015-08-21 /Date /ExpirationDate Consent Y /Consent /BenefitsCoordination /RxHistoryRequest /Body /Message 6.1.2 XML Resopnse ?xml version "1.0"? Message version "010" release "006" xmlns "http://www.ncpdp.org/schema/SCRIPT" Header To EPIC /To Last Updated: 03/25/2016 version 0.03P a g e - 27 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication History From PDMP /From MessageID 213416 /MessageID RelatesToMessageID 213416 /RelatesToMessageID SentTime 2016-03-18T09:19:26.28-04:00 /SentTime /Header Body RxHistoryResponse Response Approved/ /Response Patient Name LastName baggins /LastName FirstName bilbo /FirstName /Name Gender M /Gender DateOfBirth Date 1959-12-26 /Date /DateOfBirth Address AddressLine1 241 Shire street /AddressLine1 City SPRINGFIELD /City State IL /State ZipCode 62704 /ZipCode /Address /Patient BenefitsCoordination EffectiveDate Date 2014-08-22 /Date /EffectiveDate ExpirationDate Date 2015-08-21 /Date /ExpirationDate Consent Y /Consent /BenefitsCoordination MedicationDispensed DrugDescription HYDROCODONE-ACETAMINOPHEN /DrugDescription DrugCoded ProductCode 00591320201 /ProductCode ProductCodeQualifier ND /ProductCodeQualifier Strength 5MG-325MG /Strength /DrugCoded Quantity Value 30 /Value CodeListQualifier 87 /CodeListQualifier UnitSourceCode AC /UnitSourceCode PotencyUnitCode Tablet /PotencyUnitCode /Quantity DaysSupply 30 /DaysSupply Last Updated: 03/25/2016 version 0.03P a g e - 28 -
Document NameIllinois PMP Automated Connection Guide –PMP Medication History Refills Qualifier R /Qualifier Value 0 /Value /Refills WrittenDate Date 2012-11-26 /Date /WrittenDate LastFillDate Date 2012-11-26 /Date /LastFillDate Pharmacy StoreName MedPlus /StoreName Address AddressLine1 KR Puram /AddressLine1 City BLR /City State KA /State ZipCode 560043 /ZipCode /Address /Pharmacy Prescriber Name FirstName Dr. Johnson /FirstName /Name Address City BLR /City State KA /State
Document Illinois PMP Automated Connection Guide Name -PMP Medication History Last Updated: 03/25/2016 version 0.03 P a g e - 5 - 3. PROCESS FLOW. 3.1. High Level Process - Process flow Overview. HIS-NCPDP Method HIS-PMIX Method PMP Service NCPDP Transformer NCPDP Request / Response PMIX PMIX Request / Response
