170.314a10 Drug Formulary Checks 2014

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2014 Edition

Test Data for 170.314(a)(10) Drug-formulary checks


Approved Test Data Version 1.4 February 26, 2013


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Test Data for 170.314(a)(10) Drug-formulary checks
Reference the test procedure for test data implementation guidance.
RxNorm codes and National Drug Code (NDC) product codes are not required to meet this certification
criterion. They are provided for reference only. The certification criterion does not specify order entry as
the context for checking the drug formulary or preferred drug list. The Test Data, by listing medication
orders, are intended to support this context if the Vendor chooses order entry as the context. The drug
names in the Test Data may be used alone if the Vendor chooses a different context.
TD170.314(a)(10) 1: Automaticall y and Electronicall y Check Drug-Formulary or Preferred Drug
List
Drug Test Data - Set 1
Simvastatin 20 mg tablet by mouth once daily
RxNorm code: 312961; sample NDC product code: 52959-989
Lorazepam 0.5 mg tablet by mouth three times daily
RxNorm code: 197900; sample NDC product code: 54868-2145
Insulin Glargine (or Lantus) 10 units once daily
RxNorm code: 847230 (or 847232); sample NDC product code:
0088-2219
Drug Test Data - Set 2
Metoprolol Tartrate 50 mg tablet by mouth once daily
RxNorm code: 866514; sample NDC product code: 63629-1463
Warfarin Sodium 5 mg tablet by mouth once daily Monday, Wednesday, Friday, Sunday
RxNorm code: 855332; sample NDC product code: 54868-4286
Warfarin Sodium 2.5 mg tablet by mouth once daily Tuesday, Thursday, Saturday
RxNorm code: 855312; sample NDC product code: 54868-4400
Drug Test Data - Set 3
Digoxin 0.25 mg tablet by mouth once daily
RxNorm code: 197606; sample NDC product code: 54868-0055
Ibuprofen 800 mg tablet by mouth every 8 hours
RxNorm code: 197807; sample NDC product code: 10768-7522
Temazepam 15 mg capsule by mouth at bedtime
RxNorm code: 198241; sample NDC product code: 52959-535
Drug Test Data - Set 4
Fluticasone propionate 220 mcg 1 puff inhale twice daily
RxNorm code: 896004; sample NDC product code: 0173-0720
2014 Edition
Test Data for 170.314(a)(10) Drug-formulary checks
Approved Test Data Version 1.4 February 26, 2013


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Bupropion Hydrochloride 150 mg extended release tablet by mouth once daily
RxNorm code: 993521; sample NDC product code: 54868-5927
Esomeprazole Magnesium 40 mg capsule by mouth once daily
RxNorm code: 606730; sample NDC product code: 54868-4510
2014 Edition
Test Data for 170.314(a)(10) Drug-formulary checks
Approved Test Data Version 1.4 February 26, 2013


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Document History
Version Number Description of Change Date
1.0 Released for public comment September 7, 2012
1.1 Delivered for National Coordinator Approval December 4, 2012
1.2 Posted Approved Test Data December 14, 2012
1.3 Added document version to header
Added Document History section
J anuary 16, 2013
1.4 TD170.314(a)(10) 1: Automatically and Electronically Check
Drug-Formulary or Preferred Drug List, Drug test Data Set 1
Added option to check Lantus (RxNorm code: 847232)
instead of Insulin Glargine (RxNorm code: 847230)
February 26, 2013

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