Customer-Submitted Immunization File Information

this section details the file format which customers will submit for immunization notification files header information field # field name data type code description 1 record type an3 mandatory identifies the record type value hdr 2 version/releasenumber an3 mandatory version number of this specification value 020 3 sender id an3 30 mandatory id assigned by surescripts that identifies the customer sending the file examples p0100000000001, t0100000000001 4 sender participant password an10 not used empty element that must be included 5 receiver id an1 30 mandatory id for surescripts as the receiver of the file value s00000000000001 6 source name an1 35 not used empty element that must be included 7 transmission control number an1 10 mandatory unique identifier defined by the sender of the file note the sender shall ensure that the combination of the sender id and the transmission control number remain unique for a minimum of 18 months example 0000001000 8 transmission date dt8 mandatory date that transaction was created formatted as ccyymmdd example 20251201 9 transmission time tm8 mandatory time that transaction was created formatted as hhmmssdd example 12200101 10 transmission file type an1 3 mandatory identifier indicating the type of records contained in the file value pnl 11 transmission action an1 mandatory this is included to be consistent with other types of surescripts files value a 12 extract date dt8 mandatory date that file was created formatted as ccyymmdd example 20251201 13 file type an1 mandatory indicates if the file is meant for processing in either the testing or production environment value t = test or p = production 14 context code an0 64 not used the context code 11369 6 is always used for immunization messages record information this section specifies and describes the different record fields involved in the immunization notification file, which surescripts will validate and use to populate the unique messages that will be sent to the targeted provider records that do not meet the base validations are not processed further and are included in the targeted messaging delivery report file with an applicable error code note validation does not test data types, valid value rules or formats all elements are treated as plain text during validation field # field name data type code description 1 record type an3 mandatory identifies the record type value pnl 2 record sequence number n1 10 mandatory unique number for each record in the file 3 patient id an1 15 mandatory sender’s internal identifier for the patient note to ensure accuracy in patient matching, the patient id value should be consistent with the patient id value shared in other surescripts products 4 source system id an1 70 mandatory the assigning authority id (oid) of the targeted message sender see assigning authority id usage docid 3pykqfjocedfa4ywdyswu for more information about populating this field patient/member details 5 last name an1 50 mandatory patient’s last name 6 first name an1 30 mandatory patient’s first name 7 middle name an1 30 conditional patient’s middle name 8 phone number n 10 conditional patient’s contact phone number note do not include dashes ( ) or parentheses 9 date of birth dt8 mandatory patient’s date of birth formatted as ccyymmdd 10 gender an1 conditional patient’s administrative gender value f = female, m = male, or u = unknown/other 11 address, line 1 an1 120 conditional street information in patient’s mailing address 12 address, line 2 an1 120 conditional additional street information in patient’s mailing address 13 city an1 50 conditional city of patient’s mailing address 14 state an2 conditional state of patient’s mailing address note use usps state abbreviation 15 zip code n 5/9 conditional zip code in patient’s mailing address use the format 99999 or 999999999 recipient/target provider details 16 npi n10 conditional npi number of the patient’s provider note required for electronic delivery 17 state license number an1 15 conditional state license number of the patient’s primary care provider 18 provider id an1 15 conditional participant’s internal id for the patient’s primary care provider 19 last name an1 50 mandatory last name of patient’s provider 20 first name an1 30 conditional first name of patient’s provider 21 address, line 1 an1 120 conditional street information in mailing address of patient’s provider note required for electronic and postal mail delivery 22 address, line 2 an 1 120 conditional space for additional street information in mailing address of patient’s provider 23 city an1 50 conditional city in mailing address of patient’s provider 24 state an2 conditional usps state abbreviations for mailing address of patient’s provider note required for postal mail delivery 25 zip code n 5/9 conditional zip code in mailing address of patient’s provider use the format 99999 or 999999999 note required for electronic and postal delivery 26 phone number n1 10 conditional contact telephone number for the provider receiving the notification do not include dashes ( ) or parentheses 27 fax number n10 conditional fax number for provider to receive confidential patient information note sender must verify this as a phi secure fax number vaccine information (for immunization related messages) 28 cpt code n5 conditional assigned procedural code for vaccine 29 cvx code an2 3 conditional assigned vaccine code 30 vaccine name an1 199 mandatory descriptive name of vaccine 31 manufacturer name an1 199 mandatory name of vaccine manufacturer 32 mvx code an1 20 conditional administrative code for the vaccine manufacturer 33 lot number an1 20 mandatory lot number associated with administered vaccine 34 expiration date dt 6/8 mandatory vaccine’s expiration date, formatted as ccyymmddd or ccyymm 35 vis name an1 30 conditional name of vaccine information statement (vis) provided to the patient 36 vis date dt 6/8 conditional publication date on vis 37 administered date dt8 mandatory date that vaccine was administered to patient administration details 38 \[blank field] not used legacy data field which is no longer used 39 dose n1 20 mandatory amount of vaccine administered 40 units an1 35 mandatory units for amount administered example ml 41 \[blank field] not used legacy data field which is no longer used 42 route description an1 199 mandatory descriptive route for administration example intramuscular 43 \[blank field] not used legacy data field which is no longer used 44 site description an1 199 mandatory administration site of vaccine example left arm 45 \[blank field] not used legacy data field which is no longer used 46 dose in series n1 2 conditional if vaccination series, the number that the administered dose is in the series example 1 47 number in series n1 2 conditional if vaccination series, the total number of doses expected example 3 administering provider 48 internal id an1 15 conditional participant’s internal id for the administering provider 49 provider npi n10 conditional npi of the administering provider 50 last name an1 50 conditional last name of administering provider 51 first name an1 30 conditional first name of administering provider 52 state license number an1 15 conditional state license number of the administering provider administration/care facility 53 npi n10 conditional npi of the administering location 54 name an1 120 conditional descriptive name for administering location 55 address, line 1 an1 120 mandatory street information in mailing address of administering location 56 address, line 2 an1 120 conditional space for additional street information in mailing address of administering location 57 city an1 50 mandatory city in mailing address of administering location 58 state an2 mandatory usps state abbreviations for mailing address of administering location 59 zip code n 5/9 mandatory zip code in mailing address of administering location use the format 99999 or 999999999 60 phone number n1 10 mandatory contact telephone number for the administering location do not include dashes ( ) or parentheses processing information 61 template id an1 20 mandatory identifier used to specify the targeted messaging template to be used for a given notification available codes are assigned to the customer during implementation 62 source system id an1 35 mandatory assigning authority id (oid) of the targeted messaging sender see assigning authority id usage docid 3pykqfjocedfa4ywdyswu for more information about populating this field 63 signed consent for minor a1 conditional indication whether signed consent was obtained for a vaccine administered to a minor value y = yes, n = no 64 professional consultation complete a1 conditional indication whether professional consultation was completed at administration value y = yes, n = no 65 eligibility consultation complete a1 conditional indication whether eligibility consultation was completed at administration value y = yes, n = no legacy/not used 66 \[blank field] not used legacy data field which is no longer used 67 \[blank field] not used legacy data field which is no longer used 68 \[blank field] not used legacy data field which is no longer used 69 \[blank field] not used legacy data field which is no longer used electronic message customizations 71 context code override an0 64 conditional replaces the context code assigned in the header or the default ( 11369 6 ) with a record specific value 72 subject override an0 256 conditional replaces the default message subject line text with a record specific value default immunization notification 73 message override an0 1024 conditional replaces the default message body text with a record specific value default one of your patients recently received an immunization at one of our clinics please see attachment for details trailer information field # field name data type code description 1 record type an3 mandatory identifies the record type value trl 2 total records n1 10 mandatory total number of records in file, including the header and trailer records