---
title: Display Requirements (R.300, R.302, R.316)
slug: eprescribing/guide/display-requirements-r300-r302-r316
docTags: 
createdAt: 2026-07-09T19:51:32.504Z
---

# Overview

This section holds the application certification requirements located in the [Display Requirements](docId\:KsEmmwLDJD0i9JicT7JTP) section in the guide.

## S.300

**R.300**: The application shall be capable of providing search results that include all active pharmacies.

## R.316

**R.316**: Pharmacy applications shall incorporate a prominent visual indication to pharmacy personnel using the pharmacy practice management system that the e-prescription they are viewing is either DEA compliant, non-DEA Compliant, or both as described below.

1. Pharmacy system alerts the pharmacist that the EPCS is DEA compliant and that if “seal of approval” is not on the EPCS, the pharmacist knows it is non-DEA compliant.
2. Pharmacy system alerts pharmacist when an EPCS is non-DEA compliant.
3. Pharmacy system does \*both\* (1) and (2).

Examples of possible indications include:

- A statement on the display such as: “This prescription meets the requirements of the Drug Enforcement Administration’s electronic prescribing for controlled substances rules (21 CFR Parts 1300, 1304, 1306, & 1311).”
- A statement on the display such as: “This prescription does not meet the requirements of the Drug Enforcement Administration’s electronic prescribing for controlled substances rules (21 CFR Parts 1300, 1304, 1306, & 1311).”
- A seal-of-approval icon or symbol that incorporates in its design, language such as “Authentic EPCS – received via DEA-approved processes.”
- A seal-of-disapproval icon or symbol that incorporates in its design language such as “NON-Authentic EPCS.”
- Other similar, unmistakable visual indications that vendors might devise.

## R.302

**R.302**: To ensure patient safety, the application shall take steps to ensure that the critical fields in the [Display Requirements Tables](docId\:D0acaV_NjcERsRuWNRvO1) section (as transmitted in the message) are reviewed by the sender for accuracy and displayed or made available to the receiver. The user shall be alerted if data in any of these elements has been truncated.

:::hint{type="info"}
**Note:&#x20;**&#x54;he code value for codified fields does not have to be displayed, only the description.
:::

## Display Requirements Tables

### NewRx&#x20;

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             | X          | X            |
| Prescriber: Last Name                                                                                                              | X          | X            |
| Prescriber: Address                                                                                                                |            | X            |
| Prescriber: Primary Phone                                                                                                          |            | X            |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   | X          | X            |
| Patient: Primary Phone                                                                                                             | X          | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| Patient: Height and Weight                                                                                                         | X          | X            |
| **Pharmacy:**                                                                                                                      |            |              |
| Pharmacy Name                                                                                                                      | X          |              |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   | X          | X            |
| Quantity Value and Unit of Measure                                                                                                 | X          | X            |
| Sig (free text Sig vs. structured)                                                                                                 | X          | X            |
| Notes                                                                                                                              | X          | X            |
| Refills                                                                                                                            | X          | X            |
| Days Supply                                                                                                                        | X          | X            |
| Substitution (if dispensed as written)                                                                                             | X          | X            |
| Diagnosis Description (first, at a minimum)                                                                                        | X          | X            |
| Effective Date                                                                                                                     | X          | X            |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure | X          | X            |

### RxRenewalRequest

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             | X          | X            |
| Prescriber: Last Name                                                                                                              | X          | X            |
| Prescriber: Address                                                                                                                | X          |              |
| Prescriber: Primary Phone                                                                                                          | X          |              |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   | X          | X            |
| Patient: Primary Phone                                                                                                             | X          | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| Patient: Height and Weight                                                                                                         |            |              |
| **Pharmacy:**                                                                                                                      |            |              |
| Pharmacy Name                                                                                                                      |            | X            |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   | X          | X            |
| Quantity Value and Unit of Measure                                                                                                 | X          | X            |
| Sig (free text Sig vs. structured)                                                                                                 | X          | X            |
| Notes                                                                                                                              | X          | X            |
| Refills                                                                                                                            | X          | X            |
| Days Supply                                                                                                                        | X          | X            |
| Substitution (if dispensed as written)                                                                                             | X          | X            |
| Diagnosis Description (first, at a minimum)                                                                                        |            | X            |
| Effective Date                                                                                                                     | X          | X            |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure | X          | X            |

### RxRenewalResponse&#x20;

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only),and Supervisor:**                                           |            |              |
| Prescriber: First Name                                                                                                             | X          | X            |
| Prescriber: Last Name                                                                                                              | X          | X            |
| Prescriber: Address                                                                                                                |            | X            |
| Prescriber: Primary Phone                                                                                                          |            | X            |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   | X          | X            |
| Patient: Primary Phone                                                                                                             | X          | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| Patient: Height and Weight                                                                                                         | X          | X            |
| **Pharmacy:**                                                                                                                      |            |              |
| Pharmacy Name                                                                                                                      | X          |              |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   | X          | X            |
| Quantity Value and Unit of Measure                                                                                                 | X          | X            |
| Sig (free text Sig vs. structured)                                                                                                 | X          | X            |
| Notes                                                                                                                              | X          | X            |
| Refills                                                                                                                            | X          | X            |
| Days Supply                                                                                                                        | X          | X            |
| Substitution (if dispensed as written)                                                                                             | X          | X            |
| Diagnosis Description (first, at a minimum)                                                                                        |            | X            |
| Effective Date                                                                                                                     | X          | X            |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure | X          | X            |

### RxChangeRequest&#x20;

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             | X          | X            |
| Prescriber: Last Name                                                                                                              | X          | X            |
| Prescriber: Address                                                                                                                | X          |              |
| Prescriber: Primary Phone                                                                                                          | X          |              |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   | X          | X            |
| Patient: Primary Phone                                                                                                             | X          | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| Patient: Height and Weight                                                                                                         |            |              |
| **Pharmacy:**                                                                                                                      |            |              |
| Pharmacy Name                                                                                                                      |            | X            |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   | X          | X            |
| Quantity Value and Unit of Measure                                                                                                 | X          | X            |
| Sig (free text Sig vs. structured)                                                                                                 | X          | X            |
| Notes                                                                                                                              | X          | X            |
| Refills                                                                                                                            | X          | X            |
| Days Supply                                                                                                                        | X          | X            |
| Substitution (if dispensed as written)                                                                                             | X          | X            |
| Diagnosis Description (first, at a minimum)                                                                                        | X          | X            |
| Effective Date                                                                                                                     | X          | X            |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure | X          | X            |

### RxChangeResponse&#x20;

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             | X          | X            |
| Prescriber: Last Name                                                                                                              | X          | X            |
| Prescriber: Address                                                                                                                |            | X            |
| Prescriber: Primary Phone                                                                                                          |            | X            |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   | X          | X            |
| Patient: Primary Phone                                                                                                             | X          | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| Patient: Height and Weight                                                                                                         | X          | X            |
| **Pharmacy:**                                                                                                                      |            |              |
| Pharmacy Name                                                                                                                      | X          |              |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   | X          | X            |
| Quantity Value and Unit of Measure                                                                                                 | X          | X            |
| Sig (free text Sig vs. structured)                                                                                                 | X          | X            |
| Notes                                                                                                                              | X          | X            |
| Refills                                                                                                                            | X          | X            |
| Days Supply                                                                                                                        | X          | X            |
| Substitution (if dispensed as written)                                                                                             | X          | X            |
| Diagnosis Description (first, at a minimum)                                                                                        | X          | X            |
| Effective Date                                                                                                                     | X          | X            |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure | X          | X            |

### CancelRx

:::hint{type="info"}
**Note:&#x20;**&#x43;lick [here](docId:2jP7AdRggeOC4Yxkyfkiw) for CancelRxResponse Display Requirements information.
:::

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             |            | X            |
| Prescriber: Last Name                                                                                                              |            | X            |
| Prescriber: Address                                                                                                                |            | X            |
| Prescriber: Primary Phone                                                                                                          |            | X            |
| **Patient:**                                                                                                                       | ****       | ****         |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   | X          | X            |
| Patient: Primary Phone                                                                                                             | X          | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| **Pharmacy:**                                                                                                                      |            |              |
| Pharmacy Name                                                                                                                      | X          |              |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   | X          | X            |
| Quantity Value and Unit of Measure                                                                                                 | X          | X            |
| Sig (free text Sig vs. structured)                                                                                                 | X          | X            |
| Notes                                                                                                                              | X          | X            |
| Refills                                                                                                                            | X          | X            |
| Substitution (if dispense as written)                                                                                              |            |              |
| Effective Date                                                                                                                     | X          | X            |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure | X          | X            |

### NewRxRequest

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             | X          | X            |
| Prescriber: Last Name                                                                                                              | X          | X            |
| Prescriber: Address                                                                                                                | X          |              |
| Prescriber: Primary Phone                                                                                                          | X          |              |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   | X          | X            |
| Patient: Primary Phone                                                                                                             | X          | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| **Pharmacy:**                                                                                                                      |            |              |
| Pharmacy Name                                                                                                                      |            |              |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   | X          | X            |
| Quantity Value and Unit of Measure                                                                                                 | X          | X            |
| Sig (free text Sig vs. structured)                                                                                                 | X          | X            |
| Notes                                                                                                                              | X          | X            |
| Refills                                                                                                                            | X          | X            |
| Substitution (if dispense as written)                                                                                              |            |              |
| Effective Date                                                                                                                     |            |              |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure | X          | X            |

### NewRxResponseDenied

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             |            | X            |
| Prescriber: Last Name                                                                                                              |            | X            |
| Prescriber: Address                                                                                                                |            |              |
| Prescriber: Primary Phone                                                                                                          |            |              |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   | X          | X            |
| Patient: Primary Phone                                                                                                             | X          | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| **Pharmacy:**                                                                                                                      |            |              |
| Pharmacy Name                                                                                                                      |            |              |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   | X          | X            |
| Quantity Value and Unit of Measure                                                                                                 | X          | X            |
| Sig (free text Sig vs. structured)                                                                                                 | X          | X            |
| Notes                                                                                                                              | X          | X            |
| Refills                                                                                                                            | X          | X            |
| Substitution (if dispense as written)                                                                                              |            |              |
| Effective Date                                                                                                                     |            |              |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure |            |              |

### CancelRxResponse

| **Element Name**    | **Sender** | **Receiver** |
| ------------------- | ---------- | ------------ |
| **ResponseType**    |            |              |
| Approved            |            | X            |
| Approved/Note       |            | X            |
| Denied              |            | X            |
| Denied/DenialReason |            | X            |
| Denied/ReasonCode   |            | X            |
| Prior Dispensing    |            | X            |

### Census

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             |            | X            |
| Prescriber: Last Name                                                                                                              |            | X            |
| Prescriber: Address                                                                                                                |            | X            |
| Prescriber: Primary Phone                                                                                                          |            | X            |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   |            | X            |
| Patient: Primary Phone                                                                                                             |            | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   |            |              |
| Quantity Value and Unit of Measure                                                                                                 |            |              |
| Sig (free text Sig vs. structured)                                                                                                 |            |              |
| Notes                                                                                                                              |            |              |
| Substitution (if dispense as written)                                                                                              |            |              |
| Effective Date                                                                                                                     |            |              |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure |            |              |

### Resupply

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             |            | X            |
| Prescriber: Last Name                                                                                                              |            | X            |
| Prescriber: Address                                                                                                                |            | X            |
| Prescriber: Primary Phone                                                                                                          |            | X            |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   |            | X            |
| Patient: Primary Phone                                                                                                             |            | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   | X          | X            |
| Quantity Value and Unit of Measure                                                                                                 | X          | X            |
| Sig (free text Sig vs. structured)                                                                                                 | X          | X            |
| Notes                                                                                                                              | X          | X            |
| Substitution (if dispense as written)                                                                                              |            |              |
| Effective Date                                                                                                                     | X          | X            |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure |            |              |

### DrugAdministration

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             |            | X            |
| Prescriber: Last Name                                                                                                              |            | X            |
| Prescriber: Address                                                                                                                |            | X            |
| Prescriber: Primary Phone                                                                                                          |            | X            |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   |            | X            |
| Patient: Primary Phone                                                                                                             |            | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   | X          | X            |
| Quantity Value and Unit of Measure                                                                                                 | X          | X            |
| Sig (free text Sig vs. structured)                                                                                                 | X          | X            |
| Notes                                                                                                                              | X          | X            |
| Substitution (if dispense as written)                                                                                              |            |              |
| Effective Date                                                                                                                     | X          | X            |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure | X          | X            |

### Recertification

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             | X          | X            |
| Prescriber: Last Name                                                                                                              | X          | X            |
| Prescriber: Address                                                                                                                |            | X            |
| Prescriber: Primary Phone                                                                                                          |            | X            |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   |            | X            |
| Patient: Primary Phone                                                                                                             |            | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   | X          | X            |
| Quantity Value and Unit of Measure                                                                                                 | X          | X            |
| Sig (free text Sig vs. structured)                                                                                                 | X          | X            |
| Notes                                                                                                                              | X          | X            |
| Substitution (if dispense as written)                                                                                              | X          | X            |
| Effective Date                                                                                                                     | X          | X            |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure | X          | X            |

### RxTransferInitiationRequest

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             |            |              |
| Prescriber: Last Name                                                                                                              |            |              |
| Prescriber: Address                                                                                                                |            |              |
| Prescriber: Primary Phone                                                                                                          |            |              |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   | X          | X            |
| Patient: Primary Phone                                                                                                             | X          | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| **Pharmacy:**                                                                                                                      |            |              |
| Pharmacy Name (source and destination)                                                                                             | X          | X            |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   | X          | X            |
| Quantity Value and Unit of Measure                                                                                                 |            |              |
| Sig (free text Sig vs. structured)                                                                                                 |            |              |
| Notes                                                                                                                              | X          | X            |
| Refills                                                                                                                            |            |              |
| Days Supply                                                                                                                        |            |              |
| Substitution (if dispense as written)                                                                                              |            |              |
| Effective Date                                                                                                                     |            |              |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure | N/A        | N/A          |

### RxTransfer

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             | X          | X            |
| Prescriber: Last Name                                                                                                              | X          | X            |
| Prescriber: Address                                                                                                                | X          | X            |
| Prescriber: Primary Phone                                                                                                          | X          | X            |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   | X          | X            |
| Patient: Primary Phone                                                                                                             | X          | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| **Pharmacy:**                                                                                                                      |            |              |
| Pharmacy Name (source and destination)                                                                                             | X          | X            |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   | X          | X            |
| Quantity Value and Unit of Measure                                                                                                 | X          | X            |
| Sig (free text Sig vs. structured)                                                                                                 | X          | X            |
| Notes                                                                                                                              | X          | X            |
| Refills                                                                                                                            | X          | X            |
| Days Supply                                                                                                                        | X          | X            |
| Substitution (if dispense as written)                                                                                              | X          | X            |
| Effective Date                                                                                                                     | X          | X            |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure | N/A        | N/A          |

### RxTransferConfirm

| **Element Group / Name**                                                                                                           | **Sender** | **Receiver** |
| ---------------------------------------------------------------------------------------------------------------------------------- | ---------- | ------------ |
| **Prescriber, FollowUpPrescriber, PrescriberAgent (for receivers only), and Supervisor:**                                          |            |              |
| Prescriber: First Name                                                                                                             |            |              |
| Prescriber: Last Name                                                                                                              |            |              |
| Prescriber: Address                                                                                                                |            |              |
| Prescriber: Primary Phone                                                                                                          |            |              |
| **Patient:**                                                                                                                       |            |              |
| Patient: First Name                                                                                                                | X          | X            |
| Patient: Last Name                                                                                                                 | X          | X            |
| Patient: Address                                                                                                                   | X          | X            |
| Patient: Primary Phone                                                                                                             | X          | X            |
| Patient: Gender                                                                                                                    | X          | X            |
| Patient: Date of Birth                                                                                                             | X          | X            |
| **Pharmacy:**                                                                                                                      |            |              |
| Pharmacy Name (source and destination)                                                                                             | X          | X            |
| **Medication:**                                                                                                                    |            |              |
| Drug Description                                                                                                                   |            |              |
| Quantity Value and Unit of Measure                                                                                                 |            |              |
| Sig (free text Sig vs. structured)                                                                                                 |            |              |
| Notes                                                                                                                              |            |              |
| Refills                                                                                                                            |            |              |
| Days Supply                                                                                                                        |            |              |
| Substitution (if dispense as written)                                                                                              |            |              |
| Effective Date                                                                                                                     |            |              |
| Compound Information:<br />Description:<br />* Strength - Value, Form, and Unit of Measure
* Quantity - Value, and Unit of Measure | N/A        | N/A          |

