Prescription (pharmacy, vision)

The prescription behind a Pharmacy or Vision claim.

Pharmacy and Vision claims only. This step is for Pharmacy and Vision claims. For Professional, Institutional and Dental claims, continue to Services.

Prescription details

Prescription ID

The prescription identifier.

Date Written

The date the prescription was written.

Prescriber License Number

Prescriber Name

Medications (Pharmacy claims)

Add medication

Medication Code	Medication Name	Days Supply	Dosage Instruction
NPH-MED-20417	Amlodipine 5 mg tablets	30	One tablet once a day	Remove
NPH-MED-31872	Aspirin 81 mg tablets	30	One tablet once a day after food	Remove

Medication Code comes from the NPHIES medication code list.

Lens specifications (Vision claims)

Add lens

Eye	Product	Sphere	Cylinder	Axis (0 to 180)	Power	Back Curve	Diameter	Color	Brand
Right	Lens	-1.50	-0.50	90	-	8.6	14.0	Clear	Essilor	Remove
Left	Lens	-1.25	-0.75	85	-	8.6	14.0	Clear	Essilor	Remove

Enter only what the prescription shows. Leave the rest empty.

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