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  1. PO
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    copied!<p>Here is a sample X12 message:</p> <pre><code>ISA*00* *01*PASSWORD00*ZZ*X03400000000108*ZZ*X00450000001001*060424*1244*^*00501*000000017*1*T*&gt; GS*HI*PARTICIPANTID*PAYER123*20060424*1244*17*X*005010X217 ST*278*1234*005010X217 BHT*0007*13*123*20060424*1244 HL*1**20*1 NM1*PR*2*AETNA 1234560010*****PI*PAYER123 HL*2*1*21*1 NM1*1P*1*POPDELL*ROBERT****24*4376557IM PER*IC**TE*6515551212*FX*6513332222 HL*3*2*22*1 NM1*IL*1*SMITH*SARA****MI*352584768003G N4*KANSAS CITY*MO*64108 DMG*D8*19560414*F HL*4*3*EV*1 UM*HS*I*88 PWK*04*EL***AC*JONP56789001 HL*5*4*SS*0 SV1*N4&gt;0173042304 MSG* Oxistat Cream, 1%, 60 gram tube SE*18*1234 GE*1*17 GS*PI*PARTICIPANTID*PAYER123*20060424*1244*17*X*005010X211 ST*275*1234*005010X211 BGN*02*123456789*20060424*1244 NM1*1P*1*POPDELL*ROBERT****24*4376557IM NM1*PR*2*AETNA 1234560010*****PI*PAYER123 NM1*IL*1*SMITH*SARA****MI*352584768003G LX*1 TRN*1*JONP56789001 DTP*368*D8*20060331 CAT*AE*HL EFI*05***************ASC BIN*4896*&lt;levelone xmlns="urn:hl7-org:v3/cda" xmlns:v3dt="urn:hl7-org:v3/v3dt" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3/cda levelone_1.0.attachments.xsd"&gt; &lt;clinical_document_header&gt; &lt;id EX="a123" RT="2.16.840.1.113883.3.933"/&gt; &lt;document_type_cd V="99999-7" DN="Imidazole-Related Antifungals Attachment"/&gt; &lt;origination_dttm V="2006-01-05"/&gt; &lt;provider&gt; &lt;provider.type_cd V="PRF"/&gt; &lt;person&gt; &lt;id EX="4376557IM" RT="2.16.840.1.113883.19.10.1"/&gt; &lt;person_name&gt; &lt;nm&gt; &lt;v3dt:GIV V="Robert"/&gt; &lt;v3dt:MID V="J"/&gt; &lt;v3dt:FAM V="Podell"/&gt; &lt;v3dt:SFX V="MD"/&gt; &lt;/nm&gt; &lt;person_name.type_cd V="L" S="2.16.840.1.113883.12.200"/&gt; &lt;/person_name&gt; &lt;/person&gt; &lt;/provider&gt; &lt;patient&gt; &lt;patient.type_cd V="PATSBJ"/&gt; &lt;person&gt; &lt;id EX="352584768003G" RT="2.16.840.1.113883.19.10.2"/&gt; &lt;person_name&gt; &lt;nm&gt; &lt;v3dt:GIV V="Sara"/&gt; &lt;v3dt:MID V="J"/&gt; &lt;v3dt:FAM V="Smith"/&gt; &lt;/nm&gt; &lt;person_name.type_cd V="L" S="2.16.840.1.113883.12.200"/&gt; &lt;/person_name&gt; &lt;/person&gt; &lt;is_known_by&gt; &lt;id EX="184569" RT="2.16.840.1.1138863.19.10.3"/&gt; &lt;is_known_to&gt; &lt;id EX="352584768003G" RT="2.16.840.1.113883.19.10.2"/&gt; &lt;/is_known_to&gt; &lt;/is_known_by&gt; &lt;/patient&gt; &lt;local_header descriptor="Att_ACN"&gt; &lt;local_attr name="attachment_control_number" value="XA728302"/&gt; &lt;/local_header&gt; &lt;/clinical_document_header&gt; &lt;body&gt; &lt;section&gt; &lt;caption&gt;PRESCRIBER INFORMATION&lt;/caption&gt; &lt;paragraph&gt; &lt;caption&gt;PRESCRIBER INFORMATION, NAME&lt;/caption&gt; &lt;content&gt;Robert J. Podell, MD&lt;/content&gt; &lt;/paragraph&gt; &lt;paragraph&gt; &lt;caption&gt;PRESCRIBER INFORMATION, IDENTIFIER&lt;/caption&gt; &lt;content&gt;4376557IM&lt;/content&gt; &lt;/paragraph&gt; &lt;paragraph&gt; &lt;caption&gt;PRESCRIBER INFORMATION, SPECIALTY TAXONOMY&lt;/caption&gt; &lt;content&gt;Hepatologist (207RI0008X)&lt;/content&gt; &lt;/paragraph&gt; &lt;/section&gt; &lt;section&gt; &lt;caption&gt;PRESCRIBER CONTACT INFORMATION&lt;/caption&gt; &lt;paragraph&gt; &lt;caption&gt;PRESCRIBER CONTACT INFORMATION, PHONE NUMBER&lt;/caption&gt; &lt;content&gt;(765) 228-1234&lt;/content&gt; &lt;/paragraph&gt; &lt;paragraph&gt; &lt;caption&gt;PRESCRIBER CONTACT INFORMATION, FAX NUMBER&lt;/caption&gt; &lt;content&gt;(765) 228-3123&lt;/content&gt; &lt;/paragraph&gt; &lt;/section&gt; &lt;section&gt; &lt;caption&gt;DRUG PRESCRIBED&lt;/caption&gt; &lt;paragraph&gt; &lt;caption&gt;DRUG PRESCRIBED, NAME&lt;/caption&gt; &lt;content&gt;Oxistat Cream, 1%, 60g tube&lt;/content&gt; &lt;/paragraph&gt; &lt;paragraph&gt; &lt;caption&gt;DRUG PRESCRIBED, DRUG CODE&lt;/caption&gt; &lt;content&gt;0173-0423-04 (NDC)&lt;/content&gt; &lt;/paragraph&gt; &lt;paragraph&gt; &lt;caption&gt;DRUG PRESCRIBED, THERAPY TYPE&lt;/caption&gt; &lt;content&gt;Replacement (RPLRQ)&lt;/content&gt; &lt;/paragraph&gt; &lt;/section&gt; &lt;section&gt; &lt;caption&gt;DRUG HISTORY, PRIOR THERAPY FOR DIAGNOSIS&lt;/caption&gt; &lt;paragraph&gt; &lt;caption&gt;DRUG HISTORY, PRIOR THERAPY FOR DIAGNOSIS - DRUG NAME&lt;/caption&gt; &lt;content&gt;Tinactin Cream&lt;/content&gt; &lt;/paragraph&gt; &lt;paragraph&gt; &lt;caption&gt;DRUG HISTORY, PRIOR THERAPY FOR DIAGNOSIS - DRUG CODE&lt;/caption&gt; &lt;content&gt;0085-0715-07 (NDC)&lt;/content&gt; &lt;/paragraph&gt; &lt;paragraph&gt; &lt;caption&gt;DRUG HISTORY, PRIOR THERAPY FOR DIAGNOSIS - DURATION OF THERAPY&lt;/caption&gt; &lt;content&gt;90 days&lt;/content&gt; &lt;/paragraph&gt; &lt;paragraph&gt; &lt;caption&gt;DRUG HISTORY, PRIOR THERAPY FOR DIAGNOSIS - REASON PRIOR THERAPY DISCONTINUED&lt;/caption&gt; &lt;content&gt;Not or no longer effective (NTEFF)&lt;/content&gt; &lt;/paragraph&gt; &lt;/section&gt; &lt;section&gt; &lt;caption&gt;IMIDAZOLE-RELATED ANTIFUNGALS, RELATED DIAGNOSIS&lt;/caption&gt; &lt;paragraph&gt; &lt;caption&gt;IMIDAZOLE-RELATED ANTIFUNGALS, RELATED DIAGNOSIS&lt;/caption&gt; &lt;content&gt;Tinea Pedia (ICD-9-CM 110.4)&lt;/content&gt; &lt;/paragraph&gt; &lt;paragraph&gt; &lt;caption&gt;IMIDAZOLE-RELATED ANTIFUNGALS, RELATED DIAGNOSIS - CONFIRMED BY&lt;/caption&gt; &lt;content&gt;KOH Preparation (KOH)&lt;/content&gt; &lt;/paragraph&gt; &lt;/section&gt; &lt;section&gt; &lt;caption&gt;FUNGAL INFECTION LOCATION&lt;/caption&gt; &lt;paragraph&gt; &lt;content&gt;Between Toes, right foot (OTH)&lt;/content&gt; &lt;/paragraph&gt; &lt;/section&gt; &lt;section&gt; &lt;caption&gt;DRUG PRESCRIBED, REASON FOR TOPICAL THERAPY&lt;/caption&gt; &lt;paragraph&gt; &lt;content&gt;Hepatic Dysfunction (HDS)&lt;/content&gt; &lt;/paragraph&gt; &lt;/section&gt; &lt;section&gt; &lt;caption&gt;CO-MORBID CONDITION INFORMATION&lt;/caption&gt; &lt;paragraph&gt; &lt;caption&gt;CO-MORBID CONDITION INFORMATION, LIVER DYSFUNCTION INDICATOR&lt;/caption&gt; &lt;content&gt;yes (Y)&lt;/content&gt; &lt;/paragraph&gt; &lt;paragraph&gt; &lt;caption&gt;CO-MORBID CONDITION INFORMATION, LIVER DYSFUNCTION CONFIRMED BY&lt;/caption&gt; &lt;content&gt;Hepatic Function Panel (HFP)&lt;/content&gt; &lt;/paragraph&gt; &lt;/section&gt; &lt;section&gt; &lt;caption&gt;MEDICARE ESRD CERTIFICATION INDICATOR&lt;/caption&gt; &lt;paragraph&gt; &lt;content&gt;Yes (Y)&lt;/content&gt; &lt;/paragraph&gt; &lt;/section&gt; &lt;section&gt; &lt;caption&gt;IMIDAZOLE-RELATED ANTIFUNGALS, PRIOR THERAPY TYPE&lt;/caption&gt; &lt;paragraph&gt; &lt;content&gt;Topical (TOP)&lt;/content&gt; &lt;/paragraph&gt; &lt;/section&gt; &lt;/body&gt; &lt;/levelone&gt; SE*12*1234 GE*1*17 IEA*2*000000017 </code></pre>
 

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