PARequest (from Prescriber – Additional Information Submission)
1 min
the prescriber provides the information for the follow up question in the format indicated in the question set (by attaching a pdf document to the parequest message) \<?xml version="1 0" encoding="utf 8"?> \<message datatypesversion="20230115" transportversion="20230115" transactiondomain="script" transactionversion="20230115" structuresversion="20230115" eclversion="20230115"> \<header> \<to qualifier="py">p99999999999999\</to> \<from qualifier="d">77777777\</from> \<messageid>1234570\</messageid> \<relatestomessageid>8890\</relatestomessageid> \<senttime>2014 06 11t08 05 12 1z\</senttime> \<security> \<sender> \<tertiaryidentification>acct id inserted by ss\</tertiaryidentification> \</sender> \<receiver> \<tertiaryidentification>acct id inserted by ss\</tertiaryidentification> \</receiver> \</security> \<sendersoftware> \<sendersoftwaredeveloper>mdlite\</sendersoftwaredeveloper> \<sendersoftwareproduct>443\</sendersoftwareproduct> \<sendersoftwareversionrelease>2 1\</sendersoftwareversionrelease> \</sendersoftware> \</header> \<body> \<parequest> \<pareferenceid>77xx2\</pareferenceid> \<benefitscoordination> \<pbmmemberid>333445555\</pbmmemberid> \</benefitscoordination> \<patient> \<humanpatient> \<names> \<name xmlns\ xsi="http //www w3 org/2001/xmlschema instance"> \<lastname>smith\</lastname> \<firstname>mary\</firstname> \</name> \</names> \<genderandsex> \<administrativegender>f\</administrativegender> \</genderandsex> \<dateofbirth> \<date>1954 12 25\</date> \</dateofbirth> \<address> \<addressline1>45 east road sw\</addressline1> \<city>clancy\</city> \<stateprovince>wi\</stateprovince> \<postalcode>54999\</postalcode> \<countrycode>us\</countrycode> \</address> \</humanpatient> \</patient> \<pharmacy> \<identification> \<ncpdpid>7701630\</ncpdpid> \<npi>7878787878\</npi> \</identification> \<businessname>main street pharmacy\</businessname> \<communicationnumbers> \<primarytelephone> \<number>6155555656\</number> \</primarytelephone> \</communicationnumbers> \</pharmacy> \<prescriber> \<nonveterinarian> \<identification> \<npi>666666666\</npi> \</identification> \<names> \<name xmlns\ xsi="http //www w3 org/2001/xmlschema instance"> \<lastname>jones\</lastname> \<firstname>mark\</firstname> \</name> \</names> \<address> \<addressline1>211 central road\</addressline1> \<city>jonesville\</city> \<stateprovince>tn\</stateprovince> \<postalcode>37777\</postalcode> \<countrycode>us\</countrycode> \</address> \<communicationnumbers> \<primarytelephone> \<number>6152219800\</number> \</primarytelephone> \</communicationnumbers> \</nonveterinarian> \</prescriber> \<medicationprescribed> \<drugdescription xmlns\ xsi="http //www w3 org/2001/xmlschema instance">lovenox 40 mg per 0 4 ml prefilled syringe\</drugdescription> \<product> \<nondrugcoded> \<strength> \<strengthvalue>100\</strengthvalue> \<strengthform> \<code>c42945\</code> \</strengthform> \<strengthunitofmeasure> \<code>c42576\</code> \</strengthunitofmeasure> \</strength> \</nondrugcoded> \</product> \<quantity> \<value>30\</value> \<codelistqualifier>38\</codelistqualifier> \<quantityunitofmeasure> \<code>c48540\</code> \</quantityunitofmeasure> \</quantity> \<dayssupply>30\</dayssupply> \<diagnosis> \<clinicalinformationqualifier>1\</clinicalinformationqualifier> \<qualifier>abf\</qualifier> \<value>e11 9\</value> \<description>diabetes mellitus\</description> \</diagnosis> \<sig> \<sigtext>inject 40 mg subcutaneously once daily\</sigtext> \</sig> \</medicationprescribed> \<attachment> \<attachmentsource>patient medical record\</attachmentsource> \<attachmentdata /> \<mimetype>application/pdf\</mimetype> \</attachment> \<request> \<solicitedmodel> \<pacaseid>a101\</pacaseid> \<deadlineforreply> \<datetime>2014 10 02t23 59 59\</datetime> \</deadlineforreply> \<questionset> \<header> \<questionsetid>qs101 followup\</questionsetid> \<questionsettitle>lovenox pa form follow up question(s)\</questionsettitle> \<questionsetdescription>thank you for your request the additional information identified here is required to finish processing the case please provide at your earliest convenience; the case will remain open until the date specified in this message \</questionsetdescription> \<questionsetcontactcommunicationnumber> \<primarytelephone> \<number>5555551212\</number> \</primarytelephone> \</questionsetcontactcommunicationnumber> \<attachmentrequired>true\</attachmentrequired> \</header> \<question> \<questionid>followup q1\</questionid> \<sequencenumber>1\</sequencenumber> \<questiontext>describe result of warfarin use (include inr and date drawn) or reason why patient can't use warfarin you may attach supporting information in a pdf document \</questiontext> \<defaultnextquestionid>end\</defaultnextquestionid> \<questiontype> \<freetext> \<isfreetext>true\</isfreetext> \<answer> \<submitterprovidedanswer>please see the attached pdf containing dates of the patient's use of warfarin and inr results \</submitterprovidedanswer> \</answer> \</freetext> \</questiontype> \</question> \</questionset> \</solicitedmodel> \</request> \</parequest> \</body> \</message>