--- title: PARequest (from Prescriber – Additional Information Submission) slug: electronic-prior-auth/guide/parequest-from-prescriber-additional-information-submission docTags: createdAt: 2026-06-22T20:46:04.543Z --- 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
P99999999999999 77777777 1234570 8890 2014-06-11T08:05:12.1Z ACCT_ID_INSERTED_BY_SS ACCT_ID_INSERTED_BY_SS MDLITE 443 2.1
77XX2 333445555 SMITH MARY F 1954-12-25
45 EAST ROAD SW CLANCY WI 54999 US
7701630 7878787878 MAIN STREET PHARMACY 6155555656 666666666 JONES MARK
211 CENTRAL ROAD JONESVILLE TN 37777 US
6152219800 LOVENOX 40 MG PER 0.4 ML PREFILLED SYRINGE 100 C42945 C42576 30 38 C48540 30 1 ABF E11.9 DIABETES MELLITUS INJECT 40 MG SUBCUTANEOUSLY ONCE DAILY Patient Medical Record application/pdf A101 2014-10-02T23:59:59
QS101-FOLLOWUP Lovenox PA Form - Follow up question(s) 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. 5555551212 true
FOLLOWUP_Q1 1 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. END true Please see the attached PDF containing dates of the patient's use of Warfarin and INR results. ```