Patient File Load

7 min

The Patient File Load format will be pipe-delimited (hex7c). Each field is delimited by the pipe character (|). If a pipe-character (hex7c) is used in field data, it must be escaped with \F\. For example, Main | Street would be listed as Main \F\ Street. Each line is to be separated by a new line (hex0A) character.

Note: If mandatory fields are not included, the Patient File Load and/or patient record will not pass validation, and the patient will not be loaded or monitored. All conditional fields must be accounted for, either with data, or a placeholder delimiter.

Requirement Designation

Field Attributes:

Code	Description
mandatory	The element must be used per the specification (e.g., XML schema validation).
conditional	The element is to be used per the conditions specified.

Header Information

Note: Certain errors pertaining the Record Type and Transmission File Type fields could result the file not being processed, which would cause the response file to not be generated, preventing the visibility of resulting errors.

Field	Field Name	Type	Code	Description	Example
0	Record Type	an3	mandatory	Identifies record type.	HDR
1	Version	an3..5	mandatory	Version Number of this specification.	2.0
2	Sender ID	an15	mandatory	ID as assigned by Surescripts identifying customer sending the file.	P00000000023456
3	Sender Password	an10	mandatory	Password for customer to access the Surescripts system.	M94WJ7CW6H
4	Receiver ID	an15	mandatory	Represents Surescripts as the receiver of the file. Set to the Surescripts ID.	S00000000000006
5	Transmission Control Number	an1..10	mandatory	Unique identifier defined by the sender. The value must be unique for each file transmission and is used to map the Patient File Load to the Patient Response File.	1234567891
6	Transmission Date	dt8	mandatory	Date transaction was created (D8 - CCYYMMDD)	20060701
7	Transmission Time	tm8	mandatory	Time transaction was created (HHMMSSDD)	12200101
8	Transmission File Type	an1..4	mandatory	Identifier telling the type of File. This file load can accept patient enrollment for Panel only, Patient notification only, or for both depending on the recordtype value in the detail information. Value: PMA	PMA
9	Transmission Action	an1..10	conditional	Leave empty, or use U. If empty, field will default to U.	U
10	Extract Date	dt8	mandatory	Date File was created (CCYYMMDD)	20140104
11	Usage Indicator	an1	mandatory	Values: T = Test P = Production	T
12	Patient Population ID	an1..64	mandatory	Customer defined value to label the list of patients being loaded in this file. The same patient population can be loaded/uploaded in multiple files.	HighRisk
13	File Schedule	an1..20	conditional	Field is not currently used. Leave empty. Field will default to "ADHOC".	ADHOC
14	Look Back Period in Months	n1..3	conditional	Panel Management field. Not used by Prescription Notifications. May be left empty, or customized to pull data from one to a maximum of 12 months. Default value is set to 12.	12

Detail Information

The following sections describe separate detail information for enrollment and unenrollment file loads.

Detail Information for Enrollment

Field	Field Name	Type	Code	Description	Example(s)
0	Record Type	an3	mandatory	Identifies record type. Values: PAT = Prescription Notifications and Panel enrollment PNM = Panel enrollment PMA = Prescription Notifications enrollment Note: Patient file loads with PAT, PNM, or PMA record types cannot be combined with UNR record types.	PMA
1	Record Sequence Number	n1.. 10	mandatory	Unique Number for this detail row in the file.(Record Sequence Number starting with 1and continuing up to the number of detail records in the file.)	1 2 3
2	Assigning Authority	an1..64	mandatory	ID for the organization/system that assigned the related patient ID.	1.3.44444.666.3.2.1
3	Patient ID	an1..35	mandatory	Customer's internal Patient ID. This is case-sensitive, and reflected back in the final MH response file.	58861323
4	Last Name	an1..35	mandatory	Last name of the patient.	Jones
5	First Name	an1..35	mandatory	First name of the patient.	Robert
6	Middle Name	an1..35	conditional	Patient middle name. Sent to aid in patient matching.	Jonathan
7	Prefix	an1..10	conditional	Patient prefix. Sent to aid in patient matching.	Mr.
8	Suffix	an1..20	conditional	Patient suffix. Sent to aid in patient matching.	II
9	Address Line 1	an1..55	conditional	First line of the patient address (no C/O type information). Sent to aid in patient matching.	123 Street Avenue
10	Address Line 2	an1..55	conditional	Second line of the patient address (no C/O type information). Sent to aid in patient matching.	Unit #41
11	City Name	an2..30	conditional	Patient city name. Sent to aid in patient matching.	Jacksonville
12	State	an2...55	conditional	Only United States addresses are supported. Sent to aid in patient matching. Note: Both state abbreviations and full state names are supported.	Colorado CO
13	Postal Code	an 5..10	mandatory	Patient postal or zip code must consist of five digits, an optional hyphen (-), and up to four additional digits. The first five characters must only consist of numbers.	55123 97116-2245 200607011
14	Date of Birth	dt8	mandatory	Patient DOB (CCYYMMDD)	20060701
15	Gender	an1	mandatory	Patient gender Values: M = Male F = Female U = Unidentified	M
16	NPI	n10	mandatory	Requester NPI requesting for the MH data. This can be an organization or individual NPI. The NPI will be validated against the National Provider Identification file to verify that it exists. https://nppes.cms.hhs.gov/#/ Note: A test NPI can be used in staging, as no NPPES validation is used during the testing process. Surescripts will instead only map to test data.	1234567893
17	End Monitoring Date	dt8	conditional	Date when this patient should no longer be monitored. Leave empty to monitor the patient indefinitely. This field is only relevant for Prescription Notifications with PAT and PMA record types. Note: The End Monitoring Date must be set beyond the current date. Prescription Notifications cannot be stopped retroactively.	20231231
18	Notifications Requested for This Patient	an1..1000	conditional	The list of notifications for which the patient is being enrolled. This field is only relevant for Prescription Notifications with PAT and PMA record types. If left empty, this patient will be monitored for all contracted notifications. If this patient is to be monitored for a list of notifications that is shorter than the contracted list, include individual notifications requested in a comma separated list. Field is case insensitive. Values: PMANewRx PMARefill PMANewPrescriber PMAControlledSubstance PMANoRefillsRemaining PMARefillNotPickedUp PMACashPayRx PMAMonitoredMedRx Recommendations: Leave this field empty to make it easy for contracting new notification types in the future without need for a Patient File Load reload. If enrolling for specific notification types using this field, you must also include PMAInfo in order to receive informational notifications (e.g., patient is not found).	PMANewRx, PMARefill, PMAInfo

Detail Information for Unenrollment

Field	Field Name	Type	Code	Description	Example
0	Record Type	an3	mandatory	Identifies record type. Value: UNR = Unenroll patients Note: Patient file loads with this record type cannot be combined with PAT, PNM, or PMA record types.	UNR
1	Record Sequence Number	n1..10	mandatory	Number for this detail row in the file.	1
2	Product	an3	mandatory	Product Type. Allowed value is PMA.	PMA
3	End Monitoring Date	dt8	mandatory	This is the date when all patients who are currently being monitored will be unenrolled from Prescription Notifications (Panel does not apply). This date must be set in the future from current date. Please be aware that specific patients cannot be unenrolled using this process.	20231231

Trailer Information

Field	Field Name	Type	Code	Description	Example
0	Record Type	an3	mandatory	Identifies record type. Value: TRL	TRL
1	Total Records	n1..10	mandatory	Total Detail Records submitted	1 2 3