PAT10 Name Prefix RR Patient’s name prefix such as Mr. or Dr. (if available) PAT11 Name Suffix RR Jr. the III. Patient’s name suffix such as or (if available) PAT12 Address Information – 1 R Free-form text for street address information. PAT13 Address Information – 2 RR Free-form text for additional address information. (if available) PAT14 City Address R Free-form text for city name. PAT15 State Address RR U.S. Postal Service state code Note: Field has been sized to handle international patients not residing in the PAT16 ZIP Code Address R U.S. Postal Service ZIP code. Populate with zeros if patient address is outside the PAT17 Phone Number N Complete phone number including area code. PAT18 Date of Birth R Date patient was born. Format: CCYYMMDD PAT19 Gender Code RR Code indicating the sex of the patient. F Female M Male U Unknown PAT20 Species Code RR Used if required by the PMP to differentiate a prescription for an individual from one prescribed for an animal. 01 Human 02 Veterinary Patient
PAT10 Name Prefix Patient’s name prefix such as Mr. or Dr. RR (if available) PAT11 Name Suffix Patient’s name suffix such as Jr. or the III. RR (if available) PAT12 Address Information – 1 Free-form text for street address information. R PAT13 Address Information – 2 Free-form text for additional address information. RR (if available) PAT14 City Address Free-form text for city name. R PAT15 State Address U.S. Postal Service state code Note: Field has been sized to handle international patients not residing in the RR PAT16 ZIP Code Address U.S. Postal Service ZIP code. Populate with zeros if patient address is outside the R PAT17 Phone Number Complete phone number including area code. N PAT18 Date of Birth Date patient was born. Format: CCYYMMDD R PAT19 Gender Code Code indicating the sex of the patient. F Female M Male U Unknown RR PAT20 Species Code Used if required by the PMP to differentiate a prescription for an individual from one prescribed for an animal. 01 Human 02 Veterinary Patient RR
PMP_DataSubmittersGuide_ASAP4.2.docx