| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | date/time of request(+) | 0;1 | DATE-TIME | B | This is the date/time that the request was entered or returned from the processing site. | |
| 1 | pdx request # | 0;2 | NUMERIC | |||
| 2 | parent pdx # | 0;3 | NUMERIC | |||
| 3 | patient name(+) | 0;4 | FREE TEXT | NAME | ||
| 4 | social security #(+) | 0;5 | FREE TEXT | SS | ||
| 5 | claim # | 0;6 | FREE TEXT | |||
| 6 | date of birth | 0;7 | DATE-TIME | |||
| 7 | pid | 0;8 | FREE TEXT | |||
| 8 | patient pointer | 0;9 | POINTER | 2 | ||
| 9 | requestor duz | 0;10 | NUMERIC | |||
| 9.5 | requestor name | 0;19 | FREE TEXT | |||
| 9.7 | requestor facility | 0;20 | FREE TEXT | |||
| 9.9 | network address | 1;1 | FREE TEXT | THIS IS THE "RETURN" ADDRESS FOR THE MESSAGE. THE NETWORK ADDRESS OF THE SITE SENDING THIS MESSAGE IS STORED HERE. | ||
| 10 | pdx code | 0;11 | FREE TEXT | |||
| 11 | pdx status | 0;12 | POINTER | 394.3 | AD | |
| 11.5 | comments | 1;2 | FREE TEXT | |||
| 12 | remote message id | 0;13 | NUMERIC | |||
| 13 | local message id | 0;14 | NUMERIC | AE | ||
| 14 | authorizer duz | 0;15 | NUMERIC | |||
| 15 | authorizer name | 0;16 | FREE TEXT | |||
| 16 | authorizer facility(+) | 0;17 | FREE TEXT | |||
| 17 | purge | 0;18 | BOOLEAN | 1:YES |