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
                             488,023                   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

                             488,023                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                             488,023             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
                             488,023                   PM Prescribed medicine
                                   0                   SD Separately billing physician
                                   0                   SL Separately billing lab

CORF       14  1  $INTRFMT                              C Community or facility

                             424,627                    C Community
                              63,396                    F Facility

AMTTOT     15  9  MONYFMT                               N Total payment

                             488,023                      Amount as $$$$$$.CC

AMTCARE    24  9  MONYFMT                               N Amount paid by Medicare

                             488,023                      Amount as $$$$$$.CC

AMTCAID    33  9  MONYFMT                               N Amount paid by Medicaid

                             488,023                      Amount as $$$$$$.CC

AMTHMOP    42  9  MONYFMT                               N Amount paid by private HMO

                             488,023                      Amount as $$$$$$.CC

AMTHMOM    51  9  MONYFMT                               N Amount paid by Medicare HMO

                             488,023                      Amount as $$$$$$.CC

AMTVA      60  9  MONYFMT                               N Amount paid by Veterans Administration

                             488,023                      Amount as $$$$$$.CC

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

                             488,023                      Amount as $$$$$$.CC

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

                             488,023                      Amount as $$$$$$.CC

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

                             488,023                      Amount as $$$$$$.CC

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

                             488,023                      Amount as $$$$$$.CC

AMTDISC   105  9  MONYFMT                               N Amount of uncollected SP liability

                             488,023                      Amount as $$$$$$.CC

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

                             488,023                      Amount as $$$$$$.CC

DRUGNAME  123 30                                        C Prescribed Medicine name

PMFORM    153  2  $FORMFMT                              C Prescribed Medicine form

                              20,430                      Not ascertained
                             400,963                    1 Pill
                               2,440                   10 Patch/pad
                               1,311                   11 Topical gel/jelly
                               3,443                   12 Powder
                               4,568                    2 Liquid
                              11,110                    3 Drops
                              14,821                    4 Topical ointment
                                 148                    5 Suppository
                              15,707                    6 Inhalant/aerosol spray
                                 588                    7 Shampoo, soap
                              10,575                    8 Injection
                                 502                    9 I.V.
                               1,417                   91 Other

STRNUNI1  155  2  $STRNFMT                              C Unit of strength

                             137,961                      Missing
                               3,354                   -8 Don't know
                              43,281                   -9 Not ascertained
                              18,342                    1 Micrograms
                             261,487                    2 Milligrams
                                 237                    3 Grains
                               3,754                    4 Milliequivalents (MEQ)
                               1,787                    5 Grams (GM,G)
                              12,188                    6 Percent
                                 447                    7 International units
                               5,094                    8 Units
                                  91                   91 Other

STRNNUM1  157 10  STRNFMT                               N Number of units

                             137,961                    . Missing
                              58,823                   -9 Not ascertained
                                 666                   -8 Don't know
                               9,284                    0 Zero
                             281,289                      Number of units of strength

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

                             137,961                      Missing
                             329,009                   -1 Inapplicable
                                  49                   -8 Don't know
                               1,788                    1 Micrograms
                              18,320                    2 Milligrams
                                   1                    3 Grains
                                  61                    4 Milliequivalents (MEQ)
                                  47                    5 Grams (GM,G)
                                 609                    6 Percent
                                  20                    7 International units
                                 149                    8 Units
                                   9                   91 Other

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

                             137,961                    . Missing
                                  44                   -8 Don't know
                             329,667                   -1 Inapplicable
                                 158                    0 Zero
                              20,193                      Number of units of strength

TABNUM    179  8  TABFMT                                N Number of tablets

                             331,674                    . Missing
                              34,548                   -9 Not ascertained
                                 523                   -8 Don't know
                             121,278                1-999 Number of tablets in container

SUPPNUM   187  8  SUPPFMT                               N Number of suppositories

                             331,674                    . Missing or inapplicable
                             156,349                   -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

                             331,674                    . Missing
                             144,011                   -9 Not ascertained
                                 315                   -8 Don't know
                              12,023                      Number of units in container

AMTUNIT   205  2  $AMTFMT                               C Amount unit

                             331,674                      Missing
                               1,858                   -8 Don't know
                             142,153                   -9 Not ascertained
                                 565                    1 Ounces
                               2,692                    2 Grams
                               5,971                    3 Milliliters (ML, CC)
                                  13                    4 Milliequivalents (MEQ)
                                 170                    5 Milligrams (MG, MGM)
                                 241                    6 Micrograms (MCG)
                               2,627                    7 Doses, puffs, blisters
                                  59                   91 Other

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

                              18,633                   UN Unclassified drug products
                              24,949                   02 Analgesics
                                   8                   03 Analgesic and antihist combo
                               1,309                   05 Anesthetics
                                 105                   08 Anti-obesity drugs
                                  39                   09 Antidotes
                              12,064                   11 Antiarthritics
                              15,984                   14 Antiasthmatics
                               5,107                   17 Antihistamines
                                  29                   18 Antihistimine/Decongestant comb
                              19,712                   19 Antibiotics
                                   1                   20 Antiinfectives
                               1,742                   21 Antivirals
                               8,570                   22 Antifungals
                                 605                   23 Antiinfectives, miscellaneous
                               2,163                   26 Antineoplastics
                               4,634                   29 Antiparkinson drugs
                               4,965                   32 Autonomic drugs
                               6,416                   35 Blood
                               8,722                   36 Anticoagulants
                              25,296                   38 Cardiac drugs
                             105,064                   41 Cardiovascular
                              22,299                   44 CNS drugs
                                 383                   47 Contraceptives
                                 872                   50 Cough and cold preparations
                                   2                   53 Diagnostic
                              21,961                   56 Diuretics
                               8,797                   59 Electrolyte, caloric, & fluid rep.
                              13,847                   62 EENT preparations
                              33,221                   65 Gastrointestinal preparations
                               7,308                   68 Hormones
                              27,620                   71 Hypoglycemics
                                 982                   72 Immunosuppresant
                                  15                   74 Misc. medical supp., devices, & other
                               4,803                   77 Muscle relaxants
                              46,354                   80 Psychotherapeutic drugs
                               5,800                   83 Sedative and hypnotic drugs
                               9,394                   86 Skin preparations
                              14,186                   89 Thyroid preparations
                                 492                   92 Biologicals
                                  39                   94 Pre-natal vitamins
                               3,408                   95 Vitamins, all others
                                 120                   97 Smoking Deterrents
                                   3                   98 Herbals
                                   0                   99 Unclassified drug products

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

                                  25                      Missing
                                   0                    B Both OTC and RX
                             486,856                    F Federal or legend drug
                               1,142                    O Over-the-counter drug
                                   0                    U Unknown

ISOPCARE  240  1  $IMPFMT                               C AMTCARE payment source imputed?

                             447,541                    0 Not imputed
                              40,482                    1 Imputed

ISOPCAID  241  1  $IMPFMT                               C AMTCAID payment source imputed?

                             467,661                    0 Not imputed
                              20,362                    1 Imputed

ISOPHMOP  242  1  $IMPFMT                               C AMTHMOP payment source imputed?

                             478,898                    0 Not imputed
                               9,125                    1 Imputed

ISOPHMOM  243  1  $IMPFMT                               C AMTHMPOM payment source imputed?

                             488,023                    0 Not imputed
                                   0                    1 Imputed

ISOPVA    244  1  $IMPFMT                               C AMTVA payment source imputed?

                             484,377                    0 Not imputed
                               3,646                    1 Imputed

ISOPPRVE  245  1  $IMPFMT                               C AMTPRVE payment source imputed?

                             462,353                    0 Not imputed
                              25,670                    1 Imputed

ISOPPRVI  246  1  $IMPFMT                               C AMTPRVI payment source imputed?

                             483,745                    0 Not imputed
                               4,278                    1 Imputed

ISOPUNK   247  1  $IMPFMT                               C AMTPRVU payment source imputed?

                             488,023                    0 Not imputed
                                   0                    1 Imputed

ISOPOOP   248  1  $IMPFMT                               C AMTOOP payment source imputed?

                             445,475                    0 Not imputed
                              42,548                    1 Imputed

ISOPDISC  249  1  $IMPFMT                               C AMTDISC payment source imputed?

                             376,869                    0 Not imputed
                             111,154                    1 Imputed

ISOPOTH   250  1  $IMPFMT                               C AMTOTH payment source imputed?

                             477,166                    0 Not imputed
                              10,857                    1 Imputed

IAMTTOT   251  1  $IMPFMT                               C AMTTOT payment amount imputed?

                             454,712                    0 Not imputed
                              33,311                    1 Imputed

IAMTCARE  252  1  $IMPFMT                               C AMTCARE payment amount imputed?

                             420,438                    0 Not imputed
                              67,585                    1 Imputed

IAMTCAID  253  1  $IMPFMT                               C AMTCAID payment amount imputed?

                             460,836                    0 Not imputed
                              27,187                    1 Imputed

IAMTHMOP  254  1  $IMPFMT                               C AMTHMOP payment amount imputed?

                             474,783                    0 Not imputed
                              13,240                    1 Imputed

IAMTHMOM  255  1  $IMPFMT                               C AMTHMPOM payment amount imputed?

                             488,023                    0 Not imputed
                                   0                    1 Imputed

IAMTVA    256  1  $IMPFMT                               C AMTVA payment amount imputed?

                             476,795                    0 Not imputed
                              11,228                    1 Imputed

IAMTPRVE  257  1  $IMPFMT                               C AMTPRVE payment amount imputed?

                             445,747                    0 Not imputed
                              42,276                    1 Imputed

IAMTPRVI  258  1  $IMPFMT                               C AMTPRVI payment amount imputed?

                             481,553                    0 Not imputed
                               6,470                    1 Imputed

IAMTPRVU  259  1  $IMPFMT                               C AMTPRVU payment amount imputed?

                             488,023                    0 Not imputed
                                   0                    1 Imputed

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

                             389,184                    0 Not imputed
                              98,839                    1 Imputed

IAMTDISC  261  1  $IMPFMT                               C Imputed discount amount

                             375,446                    0 Not imputed
                             112,577                    1 Imputed

IAMTOTH   262  1  $IMPFMT                               C Imputed other amount

                             461,463                    0 Not imputed
                              26,560                    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

                             156,349                    1 Survey Reported Event
                             137,961                    2 PDE Only Event
                             193,713                    3 Survey Reported Event matched to PDE

