170 314 b 3 eprescribing 2014 test data draft v 1.0

8/12/2019 170 314 b 3 Eprescribing 2014 Test Data Draft v 1.0

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Meaningful Use Stage Two E-Prescribing Certification Testing

New Prescription Test Data

October 15, 2012

Contents

Test 1 - Hydrochlorothiazide 50 mg tablet ............................................................................................... 2

Test 2 - Klor-Con 10 mEq Extended Release tablet ................................................................................... 3

Test 3 - Catapres 0.1 mg tablet ................................................................................................................. 4

Test 4 - Cardura 2 mg tablet ..................................................................................................................... 5

Test 5 - Capoten 25 mg tablet ................................................................................................................... 6

Test 6 - Aldactone 25 mg tablet ................................................................................................................ 7

Test 7 - Lanoxin 125 mcg tablet ................................................................................................................ 8

Test 8 - Azithromycin 500 mg tablet ......................................................................................................... 9

Test 9 - Atrovent HFA Inhalation Aerosol 17 mcg/actuation, 12.9 g canister ........................................ 10

Test 10 - ProAir HFA Inhalation Aerosol 90 mcg/actuation 6.7 g canister ............................................. 11

Test 11 - Lipitor 10 mg tablet .................................................................................................................. 12

Test 12 - Lasix 20 mg tablet .................................................................................................................... 13

Test 13 - Colace 100 mg capsule ............................................................................................................. 14Test 14 - Zestril 30 mg tablet .................................................................................................................. 15

Test 15 - Norvasc 5 mg tablet ................................................................................................................. 16

Test 16 - Macrobid 100 mg capsule ........................................................................................................ 17


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Test 1 - Hydrochlorothiazide 50 mg tabletA prescription for Hydrochlorothiazide 50 mg tablets is written for patient, One Test Patientone by theirphysician, One Test Prescriberone. It is transmitted to the Test One Pharmacy to be filled.

Element Name Data MedicationMedication name Hydrochlorothiazide 50 mg tabletDirections Take 1 tablet every day by mouthQuantity 30 Refills 1 Substitution Allowed? Yes PrescriberFirst Name OneMiddle Name TestLast Name PrescriberOneClinic Name Clinic OneAddress Line 1 90001 1ST AVEAddress Line 2 STE 100City WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 1010000002DEA Number AP9010000PharmacyPharmacy Name Test One PharmacyAddress Line 1 90001 1ST STAddress Line 2 1ST FLCity WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 2010000000NCPDP ID 0999017PatientFirst Name OneMiddle Name TestLast Name PatientOneAddress Line 1 1 Test BLVDAddress Line 2 APT 1City WashingtonState DCZIP Code 20000Phone (202) 555-1212Date of Birth January 1, 1960 Gender Male


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Test 2 - Klor-Con 10 mEq Extended Release tabletA prescription for Klor-Con 10 mEq Extended Release tablets is written for patient, Two Test Patienttwoby their physician, Two Test Prescribertwo. It is transmitted to the Test Two Pharmacy to be filled.

Element Name Data MedicationMedication name Klor-Con 10 mEq Extended Release tabletDirections Take one tablet by mouth two times per dayQuantity 60Refills 1 Substitution Allowed? Yes PrescriberFirst Name TwoMiddle Name TestLast Name PrescribertwoClinic Name Clinic Two Address Line 1 90002 2ND AVEAddress Line 2 STE 200City WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 1020000000DEA Number AP9020001PharmacyPharmacy Name Test Two PharmacyAddress Line 1 90002 2ND STAddress Line 2 2ND FLCity WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 2020000008NCPDP ID 0999029PatientFirst Name TwoMiddle Name TestLast Name PatienttwoAddress Line 1 2 Test BLVDAddress Line 2 APT 2City WashingtonState DCZIP Code 20000Phone (202) 555-1212Date of Birth January 2, 1960 Gender Female


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Test 3 - Catapres 0.1 mg tabletA prescription for Catapres 0.1 mg tablets is written for patient, Three Test Patientthree by theirphysician, Three Test Prescriberthree. It is transmitted to the Test Three Pharmacy to be filled.

Element Name Data MedicationMedication name Catapres 0.1 mg tabletDirections Take 1 tablet by mouth two times a dayQuantity 60Refills 1 Substitution Allowed? Yes PrescriberFirst Name ThreeMiddle Name TestLast Name PrescriberthreeClinic Name Clinic ThreeAddress Line 1 90003 3RD AVEAddress Line 2 STE 300City WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 1030000008DEA Number AP9030002PharmacyPharmacy Name Test Three PharmacyAddress Line 1 90003 3RD STAddress Line 2 3rd FLCity WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 2030000006NCPDP ID 0999031PatientFirst Name ThreeMiddle Name TestLast Name PatientthreeAddress Line 1 3 Test BLVDAddress Line 2 APT 3City WashingtonState DCZIP Code 20000Phone (202) 555-1212Date of Birth January 3, 1960 Gender Male


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Test 4 - Cardura 2 mg tabletA prescription for Cardura 2 mg tablets is written for patient, Four Test Patientfour by their physician,Four Test Prescriberfour. It is transmitted to the Test Four Pharmacy to be filled.

Element Name Data MedicationMedication name Cardura 2 mg tabletDirections Take 1 tablet by mouth once a dayQuantity 30Refills 1 Substitution Allowed? Yes PrescriberFirst Name FourMiddle Name TestLast Name PrescriberfourClinic Name Clinic FourAddress Line 1 90004 4TH AVEAddress Line 2 STE 400City WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 1040000006DEA Number AP9040003PharmacyPharmacy Name Test Four PharmacyAddress Line 1 90004 4TH STAddress Line 2 4TH FLCity WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 2040000004NCPDP ID 0999043PatientFirst Name FourMiddle Name TestLast Name PatientfourAddress Line 1 4 Test BLVDAddress Line 2 APT 4City WashingtonState DCZIP Code 20000Phone (202) 555-1212Date of Birth January 4, 1960 Gender Female


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Test 5 - Capoten 25 mg tabletA prescription for Capoten 25 mg tablets is written for patient, Five Test Patientfive by their physician,Five Test Prescriberfive. It is transmitted to the Test Five Pharmacy to be filled.

Element Name Data MedicationMedication name Capoten 25 mg tabletDirections Take 1 tablet by mouth three times per dayQuantity 90Refills 1 Substitution Allowed? Yes PrescriberFirst Name FiveMiddle Name TestLast Name PrescriberfiveClinic Name Clinic FiveAddress Line 1 90005 5TH AVEAddress Line 2 STE 500City WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 1050000003DEA Number AP9050004PharmacyPharmacy Name Test Five PharmacyAddress Line 1 90005 5TH STAddress Line 2 5TH FLCity WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 2050000001NCPDP ID 0999055PatientFirst Name FiveMiddle Name TestLast Name PatientfiveAddress Line 1 5 Test BLVDAddress Line 2 APT 5City WashingtonState DCZIP Code 20000Phone (202) 555-1212Date of Birth January 5, 1960 Gender Male


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Test 7 - Lanoxin 125 mcg tabletA prescription for Lanoxin 125 mcg tablets is written for patient, Seven Test Patientseven by theirphysician, Seven Test Prescriberseven. It is transmitted to the Test Seven Pharmacy to be filled.

Element Name Data MedicationMedication name Lanoxin 125 mcg tabletDirections Take one tablet by mouth once per dayQuantity 60Refills 0Substitution Allowed? Yes PrescriberFirst Name SevenMiddle Name TestLast Name PrescribersevenClinic Name Clinic SevenAddress Line 1 90007 7TH AVEAddress Line 2 STE 700City WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 1070000009DEA Number AP9070006PharmacyPharmacy Name Test Seven PharmacyAddress Line 1 90007 7TH STAddress Line 2 7TH FLCity WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 2070000007NCPDP ID 0999079PatientFirst Name SevenMiddle Name TestLast Name PatientsevenAddress Line 1 7 Test BLVDAddress Line 2 APT 7City WashingtonState DCZIP Code 20000Phone (202) 555-1212Date of Birth January 7, 1960 Gender Male


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Test 9 - Atrovent HFA Inhalation Aerosol 17 mcg/actuation, 12.9 g canisterA prescription for Atrovent HFA Inhalant is written for patient, Nine Test Patientnine by their physician,Nine Test Prescribernine. It is transmitted to the Test Nine Pharmacy to be filled.

Element Name Data MedicationMedication name Atrovent HFA Inhalation Aerosol 17 mcg/actuation, 12.9 g canisterDirections Inhale 2 puffs by mouth four times a dayQuantity 1Refills 0Substitution Allowed? Yes PrescriberFirst Name NineMiddle Name TestLast Name PrescribernineClinic Name Clinic NineAddress Line 1 90009 9TH AVEAddress Line 2 STE 900City WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 1090000005DEA Number AP9090008PharmacyPharmacy Name Test Nine PharmacyAddress Line 1 90009 9TH STAddress Line 2 9TH FLCity WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 2090000003NCPDP ID 0999093PatientFirst Name NineMiddle Name TestLast Name PatientnineAddress Line 1 9 Test BLVDAddress Line 2 APT 9City WashingtonState DCZIP Code 20000Phone (202) 555-1212Date of Birth January 9, 1960 Gender Female


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Test 11 - Lipitor 10 mg tabletA prescription for Lipitor 10 mg tablets is written for patient, Eleven Test Patienteleven by theirphysician, Eleven Test Prescribereleven. It is transmitted to the Test Eleven Pharmacy to be filled.

Element Name Data MedicationMedication name Lipitor 10 mg tabletDirections Take 1 tablet by mouth once per dayQuantity 30Refills 1Substitution Allowed? Yes PrescriberFirst Name ElevenMiddle Name TestLast Name PrescriberelevenClinic Name Clinic ElevenAddress Line 1 90011 11TH AVEAddress Line 2 STE 1100City WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 1110000001DEA Number AP9110002PharmacyPharmacy Name Test Eleven PharmacyAddress Line 1 90011 11TH STAddress Line 2 11TH FLCity WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 2110000009NCPDP ID 0999118PatientFirst Name ElevenMiddle Name TestLast Name PatientelevenAddress Line 1 11 Test BLVDAddress Line 2 APT 11City WashingtonState DCZIP Code 20000Phone (202) 555-1212Date of Birth January 11, 1960 Gender Male


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Test 12 - Lasix 20 mg tabletA prescription for Lasix 20 mg tablets is written for patient, Twelve Test Patienttwelve by their physician,Twelve Test Prescribertwelve. It is transmitted to the Test Twelve Pharmacy to be filled.

Element Name Data MedicationMedication name Lasix 20 mg tabletDirections Take one tablet by mouth two times per dayQuantity 60Refills 2Substitution Allowed? Yes PrescriberFirst Name TwelveMiddle Name TestLast Name PrescribertwelveClinic Name Clinic TwelveAddress Line 1 90012 12TH AVEAddress Line 2 STE 1200City WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 1120000009DEA Number AP9120003PharmacyPharmacy Name Test Twelve PharmacyAddress Line 1 90012 12TH STAddress Line 2 12TH FLCity WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 2120000007NCPDP ID 0999120PatientFirst Name TwelveMiddle Name TestLast Name PatienttwelveAddress Line 1 12 Test BLVDAddress Line 2 APT 12City WashingtonState DCZIP Code 20000Phone (202) 555-1212Date of Birth January 12, 1960 Gender Female


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Test 13 - Colace 100 mg capsuleA prescription for Colace 100 mg capsules is written for patient, Thirteen Test Patientthirteen by theirphysician, Thirteen Test Prescriberthirteen. It is transmitted to the Test Thirteen Pharmacy to be filled.

Element Name Data MedicationMedication name Colace 100 mg capsuleDirections Take one capsule twice a day by mouthQuantity 60Refills 1Substitution Allowed? Yes PrescriberFirst Name ThirteenMiddle Name TestLast Name PrescriberthirteenClinic Name Clinic ThirteenAddress Line 1 90013 13TH AVEAddress Line 2 STE 1300City WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 1130000007DEA Number AP9130004PharmacyPharmacy Name Test Thirteen PharmacyAddress Line 1 90013 13TH STAddress Line 2 13TH FLCity WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 2130000005NCPDP ID 0999132PatientFirst Name ThirteenMiddle Name TestLast Name PatientthirteenAddress Line 1 13 Test BLVDAddress Line 2 APT 13City WashingtonState DCZIP Code 20000Phone (202) 555-1212Date of Birth January 13, 1960 Gender Female


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Test 15 - Norvasc 5 mg tabletA prescription for Norvasc 5 mg tablets is written for patient, Fifteen Test Patientfifteen by theirphysician, Fifteen Test Prescriberfifteen. It is transmitted to the Test Fifteen Pharmacy to be filled.

Element Name Data MedicationMedication name Norvasc 5 mg tabletDirections Take 1 tablet by mouth once a dayQuantity 30Refills 0Substitution Allowed? Yes PrescriberFirst Name FifteenMiddle Name TestLast Name PrescriberfifteenClinic Name Clinic FifteenAddress Line 1 90015 15TH AVEAddress Line 2 STE 1500City WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 1150000002DEA Number AP9150006PharmacyPharmacy Name Test Fifteen PharmacyAddress Line 1 90015 15TH STAddress Line 2 15TH FLCity WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 2150000000NCPDP ID 0999156PatientFirst Name FifteenMiddle Name TestLast Name PatientfifteenAddress Line 1 15 Test BLVDAddress Line 2 APT 15City WashingtonState DCZIP Code 20000Phone (202) 555-1212Date of Birth January 15, 1960 Gender Female


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Test 16 - Macrobid 100 mg capsuleA prescription for Macrobid 100 mg capsules is written for patient, Sixteen Test Patientsixteen by theirphysician, Sixteen Test Prescribersixteen. It is transmitted to the Test Sixteen Pharmacy to be filled.

Element Name Data MedicationMedication name Macrobid 100 mg capsuleDirections Take 1 capsule by mouth every 6 hours for 7 daysQuantity 28Refills 0Substitution Allowed? No PrescriberFirst Name SixteenMiddle Name TestLast Name PrescribersixteenClinic Name Clinic SixteenAddress Line 1 90016 16TH AVEAddress Line 2 STE 1600City WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 1160000000DEA Number AP9160007PharmacyPharmacy Name Test Sixteen PharmacyAddress Line 1 90016 16TH STAddress Line 2 16TH FLCity WashingtonState DCZIP Code 20000Phone (202) 555-1212NPI 2160000008NCPDP ID 0999168PatientFirst Name SixteenMiddle Name TestLast Name PatientsixteenAddress Line 1 16 Test BLVDAddress Line 2 APT 16City WashingtonState DCZIP Code 20000Phone (202) 555-1212Date of Birth January 16, 1960 Gender Male

170 314 b 3 eprescribing 2014 test data draft v 1.0

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