--- title: Panel History File Examples slug: medhistory-populations-panel/guide/panel-history-file-examples docTags: createdAt: 2026-06-10T15:15:14.155Z --- This section provides the following XML examples from within the Panel History file: - [Panel History File XML Document Structure](docId\:qw9pceRdQimuHtnOFcv0W) - [File Identifier with Date Sent](docId\:qw9pceRdQimuHtnOFcv0W) - [From Pharmacy Feed](docId\:qw9pceRdQimuHtnOFcv0W) - [From PBM/Payer Care Feed](docId\:qw9pceRdQimuHtnOFcv0W) - [Patient Not Found](docId\:qw9pceRdQimuHtnOFcv0W) - [Approved With Notes](docId\:qw9pceRdQimuHtnOFcv0W) - [AQ Reason Code](docId\:qw9pceRdQimuHtnOFcv0W) - [DJ Reason Code](docId\:qw9pceRdQimuHtnOFcv0W) ## Panel History File XML Document Structure ::Image[]{src="https://api.archbee.com/api/optimize/fNEeV2bO-J-V0NK1eH_VR/pRTl4SGJZRC1xCQhIDatw_medhistfilexmlstructure.png" position="flex-start" size="90" initialPath="../../../Resources/Images/MedHistPanelMgmt/MedHistFileXML_Structure.png" githubPath="Content/Resources/Images/MedHistPanelMgmt/MedHistFileXML_Structure.png" width="768" height="491" darkWidth="768" darkHeight="491" showCaption="false"} ## File Identifier with Date Sent (Top Portion of Panel History File) ```xml ADHOC 1234561234 2020-02-08T05:08:10 ``` ## From Pharmacy Feed ```xml

P00000000012345 S00000000000003 id3z8w35xkt03h2cb1yd3wobii0juedm 12345678:12345678:1234567812345 2020-02-08T04:38:41.076Z NOPASS SenderSoftwareDev 10.6 Version 10.1 0

1265666666 Dolittle 1234567 AUBAINE CHENIN BLANC F 1991-07-21

61761

2019-02-08 2019-03-08 Y SERTRALINE 60MG TABLETS 65862001305 ND 90 87 AC C64933 90 TAKE ONE TABLET TWO TIMES A DAY UNTIL GONE. REM 0 0 2019-12-15 2019-12-15 2019-12-18 1469123 1265437548 Walgreens

1525 N Main Pkwy Bloomington IL 61706

4012615689 TE 8925170837 FG1235179 PISCOPO BOB

1234 West DR STE E Chicago IL 617013552 AD2

5864638356 TE 8863631812 FX P2 Walgreens 1469123 D3 309678 01 ``` ## From PBM/Payer Care Feed Please refer to the example in [AQ Reason Code](docId\:qw9pceRdQimuHtnOFcv0W) where the SourceQualifier value is **PY**. :::hint{type="info"} **Note: **If the submitter chooses to send the **SourceReference** field, and the **SourceQualifier** value is **PY**, then it should be populated with prescription number from PBM/payer system from claims processing. ::: ## Patient Not Found ```xml

P00000000012345 S00000000000009 8cww2ecxk97k4a3ibwmp1pt1mgl24cdc 32345678:12345678:1234567812345 2020-02-08T04:44:58.232Z NOPASS SenderSoftwareDev 10.6 Version 10.1 0

Patient Not Found. 1265666666 Dolittle 7654321 Bandit Smokey M 1940-04-27

60131

2019-02-08 2020-02-08 Y ``` ## Approved With Note ```xml

P00000000012345 S00000000000009 wl4hsx68yfwgtklgfaxups68io4rbx6f 22345678:12345678:1234567812345 2020-02-08T04:17:47.979Z NOPASS SenderSoftwareDev 10.6 Version 10.1 0

Although a patient record was found, no medications were available. 1265666666 Dolittle 123456 BRIGHTONrighton JOEL M 1968-05-19

90210

2019-02-08 2020-02-08 Y ``` ## AQ Reason Code (Patient Has Over 300 Meds) ```xml

P00000000022835 S00000000000003 id3z8w35xkt03h2cb1yd3wobii0juedm 12345678:12345678:1234567812345 2020-02-08T04:38:41.076Z NOPASS SenderSoftwareDev 10.6 Version 10.1 0

``` **Response 1 Containing AQ Reason Code** ```xml AQ 1265666666 Dolittle 1234567 PENNINGTON REN F 1975-06-28

55555

2019-02-06 2020-02-06 Y ``` **Response 2 (Remaining Dispensed Medications up to 300)** ```xml 1265666666 Dolittle 2101111 1234567 PENNINGTON REN F 1975-06-28

55555

2019-02-06 2019-04-03 Y fentanyl 25 mcg/hr transdermal patch 00006902576 ND 25 MCG/HR C48675 10 87 AC C48524 30 REM 0 0 2019-03-08 1455555 1265466666 WALGREENS 12345

1525 N Main Pkwy Chicago IL 55555

7755555511 TE 0111118370 Valden Leah 1234387752 TE PY DSTPSDIR 895464999999 ``` ## DJ Reason Code (Patient Record Found, But No Medications Available) ```xml

D00000000093552 D00000000000008 4e2f66cc-9401-4060-b461-62e5029cc1f7 7897535:7303095:1655290060714 2022-06-15T10:47:43.000Z RRN0BD6KUE S00000000000003 Surescripts Medication History 26.1.0.774 0

DJ Although a patient record was found, no medications were available. 1154601474 11MN 560-Io7Ww25RX0fCjcH3 RetryScenario560 HALCOMB M M 1966-11-23

19145

2019-07-14 2019-07-14 Y 2021-06-15 2022-06-15 ```