--- title: PAInitiationRequest (from Initiating Party) slug: electronic-prior-auth/guide/painitiationrequest-from-initiating-party docTags: createdAt: 2026-06-22T20:46:15.639Z --- ```xml     
        EPAINI         6842917100001         4e55ea3f923b4e14a436a3f08554f488         2015-09-04T17:18:14.1Z                      MDLITE             443             2.1                  false     
                          c7eb89cc8a3c43c8818e456627a91c2d                                                   P00000000001192                     PCN9110                     994336                                  PBMA                 209837423                                      JOHNSON                     RONALD                     C                                  0998723                 9110/3TIER/25                 0398473070389475                                                                                         333445556A                                                                                                SMITH                             MAUREEN                                                                                            F                                                                   1934-11-27                                          
                        201 GOLDEN LANE                         APT 204                         CINCINNATI                         OH                         45233                         US                     
                                                                                7701631                     7878787879                                  CINCINNATI PHARMACY                 
                    100 OMNIBUS LANE                     CINCINNATI                     OH                     45202                     US                 
                                                              8595559000                                                                                                                               1992091797                                                                                                ePA-MessageManager30                             Provider                                                                   
                        123 Main st                         Minneapolis                         MN                         55123                         US                     
                                                                          6518553000                                                                               6518553001                                                                                                          LOVENOX 40 MG PER 0.4 ML PREFILLED SYRINGE                                                               58016487201                                                      100                                                              C42945                                                                                           C42576                                                                                                                                  30                     38                                              C48540                                                       30                                      1                     ABF                     E11.9                     DIABETES MELLITUS                                                       INJECT 40 MG SUBCUTANEOUSLY ONCE DAILY                                                                                 7777777777                                                                                WEISS                         TERRY                         RN                                                                                                     8595559880                                                                   8595559770                                                                  ```