Example Messages
2 min
rxhistoryrequest – surescripts to pbm/payer \<?xml version="1 0" encoding="utf 8"?> \<message datatypesversion="20230114" transportversion="20230114" transactiondomain="script" transactionversion="20230114" structuresversion="20230114" eclversion="20230114"> \<header> \<to qualifier="zzz">d00000000100853\</to> \<from qualifier="zzz">d00000000104445\</from> \<messageid>156e8ee5eabf4438b59f17897ceffe8a\</messageid> \<relatestomessageid>c93be73261c6b16509df078d25538ca3\</relatestomessageid> \<senttime>2024 05 08t15 45 33 450z\</senttime> \<security> \<sender> \<tertiaryidentification>s00000000000002\</tertiaryidentification> \</sender> \</security> \<sendersoftware> \<sendersoftwaredeveloper>surescripts\</sendersoftwaredeveloper> \<sendersoftwareproduct>medication history\</sendersoftwareproduct> \<sendersoftwareversionrelease>42 0 0\</sendersoftwareversionrelease> \</sendersoftware> \<testmessage>1\</testmessage> \</header> \<body> \<rxhistoryrequest> \<benefitscoordination> \<payeridentification> \<mutuallydefined>interchangecontrolnumber\</mutuallydefined> \</payeridentification> \<consent>y\</consent> \<pbmmemberid>pro pbm^ny^217754x\</pbmmemberid> \</benefitscoordination> \<patient> \<humanpatient> \<names> \<name> \<lastname>abingdon\</lastname> \<firstname>perseus\</firstname> \</name> \</names> \<genderandsex> \<administrativegender>m\</administrativegender> \</genderandsex> \<dateofbirth> \<date>2012 09 01\</date> \</dateofbirth> \<address> \<addressline1>1 washington st\</addressline1> \<city>montgomery\</city> \<stateprovince>al\</stateprovince> \<postalcode>10805\</postalcode> \</address> \</humanpatient> \</patient> \<prescriber> \<nonveterinarian> \<identification> \<npi>1962441741\</npi> \</identification> \<names> \<name> \<lastname>jonson\</lastname> \<firstname>tim\</firstname> \</name> \</names> \</nonveterinarian> \</prescriber> \<requesteddates> \<startdate> \<date>2023 05 09\</date> \</startdate> \<enddate> \<date>2024 05 08\</date> \</enddate> \</requesteddates> \</rxhistoryrequest> \</body> \</message> rxhistoryresponse – pbm/payer to surescripts \<?xml version="1 0" encoding="utf 8"?> \<message datatypesversion="20230114" transportversion="20230114" transactiondomain="script" transactionversion="20230114" structuresversion="20230114" eclversion="20230114"> \<header> \<to qualifier="zzz">d00000000104445\</to> \<from qualifier="zzz">d00000000100853\</from> \<messageid>8e72c1412c0e43b196bf9bbb2eee5427\</messageid> \<relatestomessageid>156e8ee5eabf4438b59f17897ceffe8a\</relatestomessageid> \<senttime>2024 05 08t15 45 35 312z\</senttime> \<sendersoftware> \<sendersoftwaredeveloper>surescripts\</sendersoftwaredeveloper> \<sendersoftwareproduct>autorespondermedhistory\</sendersoftwareproduct> \<sendersoftwareversionrelease>4 0 0 69\</sendersoftwareversionrelease> \</sendersoftware> \<testmessage>true\</testmessage> \</header> \<body> \<rxhistoryresponse> \<response> \<approved/> \</response> \<benefitscoordination> \<payeridentification> \<mutuallydefined>interchangecontrolnumber\</mutuallydefined> \</payeridentification> \<consent>y\</consent> \<pbmmemberid>pro pbm^ny^217754x\</pbmmemberid> \</benefitscoordination> \<patient> \<humanpatient> \<names> \<name> \<lastname>abingdon\</lastname> \<firstname>perseus\</firstname> \</name> \</names> \<genderandsex> \<administrativegender>m\</administrativegender> \</genderandsex> \<dateofbirth> \<date>2012 09 01\</date> \</dateofbirth> \<address> \<addressline1>1 washington st\</addressline1> \<city>montgomery\</city> \<stateprovince>al\</stateprovince> \<postalcode>10805\</postalcode> \</address> \</humanpatient> \</patient> \<prescriber> \<nonveterinarian> \<identification> \<npi>1962441741\</npi> \</identification> \<names> \<name> \<lastname>jonson\</lastname> \<firstname>tim\</firstname> \</name> \</names> \</nonveterinarian> \</prescriber> \<medicationdispensed> \<drugdescription>doxycycline hyclate 100 mg capsule\</drugdescription> \<product> \<drugcoded> \<ndc>00143314250\</ndc> \<productcode> \<code>1649988\</code> \<qualifier>scd\</qualifier> \</productcode> \<strength> \<strengthvalue>100\</strengthvalue> \<strengthunitofmeasure> \<code>c28253\</code> \</strengthunitofmeasure> \</strength> \</drugcoded> \</product> \<quantity> \<value>20\</value> \<codelistqualifier>87\</codelistqualifier> \<quantityunitofmeasure> \<code>c48480\</code> \</quantityunitofmeasure> \</quantity> \<dayssupply>10\</dayssupply> \<writtendate> \<date>2024 02 07\</date> \</writtendate> \<lastfilldate> \<date>2024 02 07\</date> \</lastfilldate> \<substitutions> \<substitutions>0\</substitutions> \</substitutions> \<diagnosis> \<clinicalinformationqualifier>1\</clinicalinformationqualifier> \<qualifier>abf\</qualifier> \<value>n390\</value> \<description>chronic urinary tract infection\</description> \</diagnosis> \<refillsremaining>0\</refillsremaining> \<historyprescriberordernumber>pa 5369\</historyprescriberordernumber> \<historysource> \<source> \<sourcequalifier>payer\</sourcequalifier> \</source> \</historysource> \</medicationdispensed> \<medicationdispensed> \<drugdescription>methylprednisolone 4 mg dosepak\</drugdescription> \<product> \<drugcoded> \<ndc>59762444002\</ndc> \<productcode> \<code>762675\</code> \<qualifier>gpk\</qualifier> \</productcode> \<strength> \<strengthvalue>4\</strengthvalue> \<strengthunitofmeasure> \<code>c28253\</code> \</strengthunitofmeasure> \</strength> \</drugcoded> \</product> \<quantity> \<value>21\</value> \<codelistqualifier>87\</codelistqualifier> \<quantityunitofmeasure> \<code>c48542\</code> \</quantityunitofmeasure> \</quantity> \<dayssupply>21\</dayssupply> \<writtendate> \<date>2024 03 30\</date> \</writtendate> \<lastfilldate> \<date>2024 03 30\</date> \</lastfilldate> \<substitutions> \<substitutions>0\</substitutions> \</substitutions> \<diagnosis> \<clinicalinformationqualifier>1\</clinicalinformationqualifier> \<qualifier>abf\</qualifier> \<value>h1032\</value> \<description>unspecified acute conjunctivitis, left eye\</description> \</diagnosis> \<refillsremaining>0\</refillsremaining> \<historyprescriberordernumber>pa 5398\</historyprescriberordernumber> \<historysource> \<source> \<sourcequalifier>payer\</sourcequalifier> \</source> \</historysource> \</medicationdispensed> \<medicationdispensed> \<drugdescription>tobramycin and dexamethasone ophthalmic suspension\</drugdescription> \<product> \<nondrugcoded> \<productcode> \<code>24208029510\</code> \<qualifier>up\</qualifier> \</productcode> \<productcode> \<code>309683\</code> \<qualifier>scd\</qualifier> \</productcode> \<strength> \<strengthvalue>3/1\</strengthvalue> \<strengthunitofmeasure> \<code>c28253\</code> \</strengthunitofmeasure> \</strength> \<deaschedule> \<code>c48679\</code> \</deaschedule> \</nondrugcoded> \</product> \<quantity> \<value>10\</value> \<codelistqualifier>87\</codelistqualifier> \<quantityunitofmeasure> \<code>c28254\</code> \</quantityunitofmeasure> \</quantity> \<dayssupply>7\</dayssupply> \<writtendate> \<date>2024 01 11\</date> \</writtendate> \<lastfilldate> \<date>2024 01 11\</date> \</lastfilldate> \<substitutions> \<substitutions>0\</substitutions> \</substitutions> \<diagnosis> \<clinicalinformationqualifier>1\</clinicalinformationqualifier> \<qualifier>abf\</qualifier> \<value>h10502\</value> \<description>unspecified blepharoconjunctivitis, left eye\</description> \</diagnosis> \<priorauthorizationstatus>a\</priorauthorizationstatus> \<refillsremaining>0\</refillsremaining> \<historyprescriberordernumber>pa 5358\</historyprescriberordernumber> \<historysource> \<source> \<sourcequalifier>payer\</sourcequalifier> \</source> \</historysource> \</medicationdispensed> \<medicationdispensed> \<drugdescription>dexamethasone 4 mg/ml vial\</drugdescription> \<product> \<drugcoded> \<ndc>00641614501\</ndc> \<productcode> \<code>1116927\</code> \<qualifier>scd\</qualifier> \</productcode> \<strength> \<strengthvalue>4\</strengthvalue> \<strengthunitofmeasure> \<code>c42576\</code> \</strengthunitofmeasure> \</strength> \</drugcoded> \</product> \<quantity> \<value>30\</value> \<codelistqualifier>87\</codelistqualifier> \<quantityunitofmeasure> \<code>c28254\</code> \</quantityunitofmeasure> \</quantity> \<dayssupply>30\</dayssupply> \<writtendate> \<date>2024 03 19\</date> \</writtendate> \<lastfilldate> \<date>2024 03 19\</date> \</lastfilldate> \<substitutions> \<substitutions>0\</substitutions> \</substitutions> \<diagnosis> \<clinicalinformationqualifier>1\</clinicalinformationqualifier> \<qualifier>abf\</qualifier> \<value>m659\</value> \<description>synovitis and tenosynovitis, unspecified\</description> \</diagnosis> \<refillsremaining>0\</refillsremaining> \<historyprescriberordernumber>pa 5387\</historyprescriberordernumber> \<historysource> \<source> \<sourcequalifier>payer\</sourcequalifier> \</source> \</historysource> \</medicationdispensed> \<medicationdispensed> \<drugdescription>bd 3ml syringe 25g x 1\</drugdescription> \<quantity> \<value>30\</value> \<codelistqualifier>87\</codelistqualifier> \<quantityunitofmeasure> \<code>c48540\</code> \</quantityunitofmeasure> \</quantity> \<writtendate> \<date>2024 03 19\</date> \</writtendate> \<lastfilldate> \<date>2024 03 19\</date> \</lastfilldate> \<substitutions> \<substitutions>0\</substitutions> \</substitutions> \<historyprescriberordernumber>pa 5388\</historyprescriberordernumber> \<historysource> \<source> \<sourcequalifier>payer\</sourcequalifier> \</source> \</historysource> \</medicationdispensed> \<medicationdispensed> \<drugdescription>sprycel 70 mg tablet\</drugdescription> \<product> \<drugcoded> \<ndc>00003052411\</ndc> \<productcode> \<code>643177\</code> \<qualifier>sbd\</qualifier> \</productcode> \<strength> \<strengthvalue>70\</strengthvalue> \<strengthunitofmeasure> \<code>c28253\</code> \</strengthunitofmeasure> \</strength> \</drugcoded> \</product> \<quantity> \<value>60\</value> \<codelistqualifier>87\</codelistqualifier> \<quantityunitofmeasure> \<code>c48542\</code> \</quantityunitofmeasure> \</quantity> \<dayssupply>60\</dayssupply> \<writtendate> \<date>2024 04 13\</date> \</writtendate> \<lastfilldate> \<date>2024 04 13\</date> \</lastfilldate> \<substitutions> \<substitutions>1\</substitutions> \</substitutions> \<diagnosis> \<clinicalinformationqualifier>1\</clinicalinformationqualifier> \<qualifier>abf\</qualifier> \<value>c921\</value> \<description>chronic myelogenous leukemia, philadelphia chromosome (ph1) positive\</description> \</diagnosis> \<priorauthorizationnumber>ab829933 xhjs2\</priorauthorizationnumber> \<priorauthorizationstatus>a\</priorauthorizationstatus> \<refillsremaining>1\</refillsremaining> \<historyprescriberordernumber>pa 5434\</historyprescriberordernumber> \<historysource> \<source> \<sourcequalifier>payer\</sourcequalifier> \</source> \</historysource> \</medicationdispensed> \<requesteddates> \<startdate> \<date>2023 05 09\</date> \</startdate> \<enddate> \<date>2024 05 08\</date> \</enddate> \</requesteddates> \</rxhistoryresponse> \</body>