RIC         1  2  $RIC                                  C Record Identification Code

                                   0                    A Administrative Data
                                   0                   DU Dental Events
                                   0                   FA Facility Events
                                   0                    H HMO Supplement
                                   0                   IA Income and Assets
                                   0                   IP Inpatient Hospital Events
                                   0                   IU Institutional Events
                                   0                    K Key Record
                                   0                   KN Knowledge and Information Needs
                                   0                   MD MDS
                                   0                   MP Medical Provider Events
                                   0                    N Non-Respondent
                                   0                   OA OASIS
                                   0                   OP Outpatient Events
                                   0                   PA Patient Activation
                             461,252                   PM Prescribed Medicine Events
                                   0                   PS Person Summary
                                   0                   RX Drug Coverage
                                   0                   SS Service Summary
                                   0                    X Cross Sectional Weights
                                   0                   XE Ever Enrolled Weights
                                   0                   X2 2 year Weights
                                   0                   X3 3 year Weights
                                   0                   X4 4 year Weights
                                   0                    1 Survey Identification (Demographic)
                                   0                   10 MDS/OAS Timeline
                                   0                    2 Health Status/Functioning (Community)
                                   0                   2F Health Status/Functioning (Facility)
                                   0                   2H Health Status/Functioning (Helper)
                                   0                   2P Health Status/Functioning (Prevention)
                                   0                    3 Access to Care
                                   0                    4 Health Insurance
                                   0                    5 Enumeration
                                   0                    6 Facility Residence History
                                   0                    7 Facility Characteristics
                                   0                   7S SNF Characteristics
                                   0                    8 Interview Description
                                   0                    9 Residence Timeline

VERSION     3  1  $VERSION                              C Version Number

                             461,252                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                             461,252             LOW-HIGH BASEID Count

TYPE       12  2  $EVNTTYP                              C Event type-Prescribed Medicine

                                   0                   DU Dental
                                   0                   ER Emergency Room
                                   0                   IP Inpatient
                                   0                   IU Institutional utilization
                                   0                   MP Medical provider
                                   0                   OM Other medical expense
                                   0                   OP Outpatient
                             461,252                   PM Prescribed medicine
                                   0                   SD Separately billing physician
                                   0                   SL Separately billing lab

CORF       14  1  $INTRFMT                              C Community or facility

                             412,289                    C Community
                              48,963                    F Facility

AMTTOT     15  9  MONYFMT                               N Total payment

                             461,252                      Amount as $$$$$$.CC

AMTCARE    24  9  MONYFMT                               N Amount paid by Medicare

                             461,252                      Amount as $$$$$$.CC

AMTCAID    33  9  MONYFMT                               N Amount paid by Medicaid

                             461,252                      Amount as $$$$$$.CC

AMTHMOP    42  9  MONYFMT                               N Amount paid by private HMO

                             461,252                      Amount as $$$$$$.CC

AMTHMOM    51  9  MONYFMT                               N Amount paid by Medicare HMO

                             461,252                      Amount as $$$$$$.CC

AMTVA      60  9  MONYFMT                               N Amount paid by Veterans Administration

                             461,252                      Amount as $$$$$$.CC

AMTPRVE    69  9  MONYFMT                               N Amt paid by employer-sponsored priv ins

                             461,252                      Amount as $$$$$$.CC

AMTPRVI    78  9  MONYFMT                               N Amt paid by individually-purch priv ins

                             461,252                      Amount as $$$$$$.CC

AMTPRVU    87  9  MONYFMT                               N Amt paid by priv ins (unknown purchased)

                             461,252                      Amount as $$$$$$.CC

AMTOOP     96  9  MONYFMT                               N Amount paid out-of-pocket (OOP)

                             461,252                      Amount as $$$$$$.CC

AMTDISC   105  9  MONYFMT                               N Amount of uncollected SP liability

                             461,252                      Amount as $$$$$$.CC

AMTOTH    114  9  MONYFMT                               N Amount paid by other payor(s)

                             461,252                      Amount as $$$$$$.CC

DRUGNAME  123 30                                        C Prescribed Medicine name

PMFORM    153  2  $FORMFMT                              C Prescribed Medicine form

                              33,456                      Not ascertained
                             381,422                    1 Pill
                               2,249                   10 Patch/pad
                                 726                   11 Topical gel/jelly
                               1,563                   12 Powder
                               3,230                    2 Liquid
                               8,996                    3 Drops
                               5,746                    4 Topical ointment
                                 169                    5 Suppository
                              13,952                    6 Inhalant/aerosol spray
                                 140                    7 Shampoo, soap
                               8,528                    8 Injection
                                 299                    9 I.V.
                                 776                   91 Other

STRNUNI1  155  2  $STRNFMT                              C Unit of strength

                             105,451                      Missing
                               1,734                   -8 Don't know
                              60,018                   -9 Not ascertained
                              16,656                    1 Micrograms
                             258,602                    2 Milligrams
                                 215                    3 Grains
                               3,662                    4 Milliequivalents (MEQ)
                               1,605                    5 Grams (GM,G)
                               8,517                    6 Percent
                                 530                    7 International units
                               3,544                    8 Units
                                 718                   91 Other

STRNNUM1  157 10  STRNFMT                               N Number of units

                             105,451                    . Missing
                              70,269                   -9 Not ascertained
                               1,759                   -8 Don't know
                               8,713                    0 Zero
                             275,060                      Number of units of strength

STRNUNI2  167  2  $STRNFMT                              C Unit of strength/2nd combination

                             105,451                      Missing
                             334,908                   -1 Inapplicable
                                  62                   -8 Don't know
                               1,750                    1 Micrograms
                              18,216                    2 Milligrams
                                  19                    3 Grains
                                  43                    4 Milliequivalents (MEQ)
                                  21                    5 Grams (GM,G)
                                 411                    6 Percent
                                   1                    7 International units
                                 179                    8 Units
                                 191                   91 Other

STRNNUM2  169 10  STRNFMT                               N Number of units/2nd combination

                             105,451                    . Missing
                                  81                   -8 Don't know
                             335,381                   -1 Inapplicable
                                  76                    0 Zero
                              20,263                      Number of units of strength

TABNUM    179  8  TABFMT                                N Number of tablets

                             275,833                    . Missing
                              46,463                   -9 Not ascertained
                                 515                   -8 Don't know
                             138,441                1-999 Number of tablets in container

SUPPNUM   187  8  SUPPFMT                               N Number of suppositories

                             275,833                    . Missing or inapplicable
                             185,419                   -9 Not ascertained
                                   0                 1-98 Number of suppositories in container
                                   0                   99 99 or more suppositories in container

AMTNUM    195 10  AMTFMT                                N Amount of prescr. medicine in container

                             275,833                    . Missing
                             173,747                   -9 Not ascertained
                                 423                   -8 Don't know
                              11,249                      Number of units in container

AMTUNIT   205  2  $AMTFMT                               C Amount unit

                             275,833                      Missing
                               1,347                   -8 Don't know
                             172,400                   -9 Not ascertained
                                 592                    1 Ounces
                               2,316                    2 Grams
                               5,637                    3 Milliliters (ML, CC)
                                  54                    4 Milliequivalents (MEQ)
                                 218                    5 Milligrams (MG, MGM)
                                 275                    6 Micrograms (MCG)
                               2,304                    7 Doses, puffs, blisters
                                 276                   91 Other

THERCC    237  2  $THERFMT                              C F.D.B. generic therapeutic class

                              18,571                   UN Unclassified drug products
                              23,861                   02 Analgesics
                                  16                   03 Analgesic and antihist combo
                               1,150                   05 Anesthetics
                                  61                   08 Anti-obesity drugs
                                  38                   09 Antidotes
                              12,478                   11 Antiarthritics
                              15,368                   14 Antiasthmatics
                               4,161                   17 Antihistamines
                                 120                   18 Antihistimine/Decongestant comb
                                   0                   19 Antibiotics
                              13,969                   20 Antiinfectives
                                   0                   21 Antivirals
                                   0                   22 Antifungals
                               5,640                   23 Antiinfectives, miscellaneous
                               2,193                   26 Antineoplastics
                               4,396                   29 Antiparkinson drugs
                              27,299                   32 Autonomic drugs
                               7,626                   35 Blood
                               7,536                   36 Anticoagulants
                              25,103                   38 Cardiac drugs
                              86,296                   41 Cardiovascular
                              18,242                   44 CNS drugs
                                 471                   47 Contraceptives
                                 951                   50 Cough and cold preparations
                                   2                   53 Diagnostic
                              22,974                   56 Diuretics
                               8,650                   59 Electrolyte, caloric, & fluid rep.
                              13,141                   62 EENT preparations
                              30,522                   65 Gastrointestinal preparations
                               7,493                   68 Hormones
                              26,975                   71 Hypoglycemics
                               1,020                   72 Immunosuppresant
                                  31                   74 Misc. medical supp., devices, & other
                               4,851                   77 Muscle relaxants
                              40,661                   80 Psychotherapeutic drugs
                               5,203                   83 Sedative and hypnotic drugs
                               4,835                   86 Skin preparations
                              14,736                   89 Thyroid preparations
                                 253                   92 Biologicals
                                 145                   94 Pre-natal vitamins
                               3,930                   95 Vitamins, all others
                                 272                   97 Smoking Deterrents
                                  12                   98 Herbals
                                   0                   99 Unclassified drug products

OTCLEG    239  1  $OTCFMT                               C Over-the-counter/legend indicator

                                   0                    B Both OTC and RX
                             459,570                    F Federal or legend drug
                               1,682                    O Over-the-counter drug
                                   0                    U Unknown

ISOPCARE  240  1  $IMPFMT                               C AMTCARE payment source imputed?

                             410,066                    0 Not imputed
                              51,186                    1 Imputed

ISOPCAID  241  1  $IMPFMT                               C AMTCAID payment source imputed?

                             433,716                    0 Not imputed
                              27,536                    1 Imputed

ISOPHMOP  242  1  $IMPFMT                               C AMTHMOP payment source imputed?

                             445,350                    0 Not imputed
                              15,902                    1 Imputed

ISOPHMOM  243  1  $IMPFMT                               C AMTHMPOM payment source imputed?

                             461,252                    0 Not imputed
                                   0                    1 Imputed

ISOPVA    244  1  $IMPFMT                               C AMTVA payment source imputed?

                             452,541                    0 Not imputed
                               8,711                    1 Imputed

ISOPPRVE  245  1  $IMPFMT                               C AMTPRVE payment source imputed?

                             412,213                    0 Not imputed
                              49,039                    1 Imputed

ISOPPRVI  246  1  $IMPFMT                               C AMTPRVI payment source imputed?

                             453,281                    0 Not imputed
                               7,971                    1 Imputed

ISOPUNK   247  1  $IMPFMT                               C AMTPRVU payment source imputed?

                             461,252                    0 Not imputed
                                   0                    1 Imputed

ISOPOOP   248  1  $IMPFMT                               C AMTOOP payment source imputed?

                             368,242                    0 Not imputed
                              93,010                    1 Imputed

ISOPDISC  249  1  $IMPFMT                               C AMTDISC payment source imputed?

                             321,350                    0 Not imputed
                             139,902                    1 Imputed

ISOPOTH   250  1  $IMPFMT                               C AMTOTH payment source imputed?

                             438,193                    0 Not imputed
                              23,059                    1 Imputed

IAMTTOT   251  1  $IMPFMT                               C AMTTOT payment amount imputed?

                             426,552                    0 Not imputed
                              34,700                    1 Imputed

IAMTCARE  252  1  $IMPFMT                               C AMTCARE payment amount imputed?

                             380,498                    0 Not imputed
                              80,754                    1 Imputed

IAMTCAID  253  1  $IMPFMT                               C AMTCAID payment amount imputed?

                             429,030                    0 Not imputed
                              32,222                    1 Imputed

IAMTHMOP  254  1  $IMPFMT                               C AMTHMOP payment amount imputed?

                             443,431                    0 Not imputed
                              17,821                    1 Imputed

IAMTHMOM  255  1  $IMPFMT                               C AMTHMPOM payment amount imputed?

                             461,252                    0 Not imputed
                                   0                    1 Imputed

IAMTVA    256  1  $IMPFMT                               C AMTVA payment amount imputed?

                             449,396                    0 Not imputed
                              11,856                    1 Imputed

IAMTPRVE  257  1  $IMPFMT                               C AMTPRVE payment amount imputed?

                             400,534                    0 Not imputed
                              60,718                    1 Imputed

IAMTPRVI  258  1  $IMPFMT                               C AMTPRVI payment amount imputed?

                             451,900                    0 Not imputed
                               9,352                    1 Imputed

IAMTPRVU  259  1  $IMPFMT                               C AMTPRVU payment amount imputed?

                             461,252                    0 Not imputed
                                   0                    1 Imputed

IAMTOOP   260  1  $IMPFMT                               C Imputed out-of-pocket amount

                             344,754                    0 Not imputed
                             116,498                    1 Imputed

IAMTDISC  261  1  $IMPFMT                               C Imputed discount amount

                             321,088                    0 Not imputed
                             140,164                    1 Imputed

IAMTOTH   262  1  $IMPFMT                               C Imputed other amount

                             435,378                    0 Not imputed
                              25,874                    1 Imputed

PMEID     263 16                                        C RICPME event ID

FDB_BN    279 30                                        C First Databank brand name

FDB_GNN   309 30                                        C First Databank generic name

FDB_STR   339 10                                        C First Databank strength

FDB_RTE   349 40                                        C First Databank Route

SERV_DT   389  8                                        C Service Date

NDC_CD    397 19                                        C NDC Code

QNTY      416  8                                        N Quantity

DAYSUPP   424  3                                        N Days Supplied

PDEFLAG   427  1  MATCH                                 N PDE Match Indicator

                             185,419                    1 Survey Reported Event
                             105,451                    2 PDE Only Event
                             170,382                    3 Survey Reported Event matched to PDE

