Sequential Number: 1
Description: Requested Give Code
Data Type: CWE
Item ID: 292
Table: 9999
Sequential Number: 2
Description: Requested Give Amount - Minimum
Data Type: NM
Item ID: 293
Sequential Number: 3
Description: Requested Give Amount - Maximum
Data Type: NM
Item ID: 294
Sequential Number: 4
Description: Requested Give Units
Data Type: CWE
Item ID: 295
Table: 9999
Sequential Number: 5
Description: Requested Dosage Form
Data Type: CWE
Item ID: 296
Table: 9999
RXO.6_Provider_s_Pharmacy_Treatment_InstructionsSequential Number: 6
Description: Provider's Pharmacy/Treatment Instructions
Data Type: CWE
Item ID: 297
Table: 9999
RXO.7_Provider_s_Administration_InstructionsSequential Number: 7
Description: Provider's Administration Instructions
Data Type: CWE
Item ID: 298
Table: 9999
Sequential Number: 9
Description: Allow Substitutions
Data Type: ID
Item ID: 300
Table: 0161
Sequential Number: 10
Description: Requested Dispense Code
Data Type: CWE
Item ID: 301
Table: 9999
Sequential Number: 11
Description: Requested Dispense Amount
Data Type: NM
Item ID: 302
Sequential Number: 12
Description: Requested Dispense Units
Data Type: CWE
Item ID: 303
Table: 9999
Sequential Number: 13
Description: Number Of Refills
Data Type: NM
Item ID: 304
RXO.14_Ordering_Provider_s_DEA_NumberSequential Number: 14
Description: Ordering Provider's DEA Number
Data Type: XCN
Item ID: 305
RXO.15_Pharmacist_Treatment_Supplier_s_Verifier_IDSequential Number: 15
Description: Pharmacist/Treatment Supplier's Verifier ID
Data Type: XCN
Item ID: 306
Sequential Number: 16
Description: Needs Human Review
Data Type: ID
Item ID: 307
Table: 0136
Sequential Number: 17
Description: Requested Give Per (Time Unit)
Data Type: ST
Item ID: 308
Sequential Number: 18
Description: Requested Give Strength
Data Type: NM
Item ID: 1121
Sequential Number: 19
Description: Requested Give Strength Units
Data Type: CWE
Item ID: 1122
Table: 9999
RXO.20_IndicationSequential Number: 20
Description: Indication
Data Type: CWE
Item ID: 1123
Table: 9999
Sequential Number: 21
Description: Requested Give Rate Amount
Data Type: ST
Item ID: 1218
Sequential Number: 22
Description: Requested Give Rate Units
Data Type: CWE
Item ID: 1219
Table: 9999
Sequential Number: 23
Description: Total Daily Dose
Data Type: CQ
Item ID: 329
RXO.24_Supplementary_CodeSequential Number: 24
Description: Supplementary Code
Data Type: CWE
Item ID: 1476
Table: 9999
Sequential Number: 25
Description: Requested Drug Strength Volume
Data Type: NM
Item ID: 1666
Sequential Number: 26
Description: Requested Drug Strength Volume Units
Data Type: CWE
Item ID: 1667
Table: 9999
Sequential Number: 27
Description: Pharmacy Order Type
Data Type: ID
Item ID: 1668
Table: 0480
Sequential Number: 28
Description: Dispensing Interval
Data Type: NM
Item ID: 1669
Sequential Number: 29
Description: Medication Instance Identifier
Data Type: EI
Item ID: 2149
Sequential Number: 30
Description: Segment Instance Identifier
Data Type: EI
Item ID: 2150
Sequential Number: 31
Description: Mood Code
Data Type: CNE
Item ID: 2151
Table: 0725
Sequential Number: 32
Description: Dispensing Pharmacy
Data Type: CWE
Item ID: 1681
Table: 9999
Sequential Number: 33
Description: Dispensing Pharmacy Address
Data Type: XAD
Item ID: 1682
Sequential Number: 34
Description: Deliver-to Patient Location
Data Type: PL
Item ID: 1683
Sequential Number: 35
Description: Deliver-to Address
Data Type: XAD
Item ID: 1684
RXO.36_Pharmacy_Phone_NumberSequential Number: 36
Description: Pharmacy Phone Number
Data Type: XTN
Item ID: 2309
any