<?xml version=“1.0” encoding=“UTF-8”?> <Claim xmlns=“hl7.org/fhir”>
<id value="960150"/> <meta> <security> <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/> <code value="HTEST"/> <display value="test health data"/> </security> </meta> <identifier> <system value="http://happyhospital.com/claim"/> <value value="9612345"/> </identifier> <status value="active"/> <type> <coding> <system value="http://terminology.hl7.org/CodeSystem/claim-type"/> <code value="institutional"/> </coding> </type> <subType> <coding> <system value="http://terminology.hl7.org/CodeSystem/ex-claimsubtype"/> <code value="emergency"/> </coding> </subType> <use value="claim"/> <patient> <reference value="Patient/1"/> </patient> <created value="2014-08-16"/> <enterer> <identifier> <system value="http://jurisdiction.org/facilities/HOSP1234/users"/> <value value="UC1234"/> </identifier> </enterer> <insurer> <reference value="Organization/2"/> </insurer> <provider> <reference value="Organization/1"/> </provider> <priority> <coding> <code value="normal"/> </coding> </priority> <payee> <type> <coding> <code value="provider"/> </coding> </type> </payee> <facility> <identifier> <system value="http://jurisdiction.org/facilities"/> <value value="HOSP1234"/> </identifier> </facility> <careTeam> <sequence value="1"/> <provider> <reference value="Practitioner/example"/> </provider> </careTeam> <diagnosis> <sequence value="1"/> <diagnosisCodeableConcept> <coding> <code value="654456"/> </coding> </diagnosisCodeableConcept> </diagnosis> <procedure> <sequence value="1"/> <type> <coding> <code value="primary"/> </coding> </type> <date value="2014-08-16"/> <procedureCodeableConcept> <coding> <code value="SDI9901"/> </coding> <text value="Subcutaneous diagnostic implant"/> </procedureCodeableConcept> <udi> <reference value="Device/example"/> </udi> </procedure> <insurance> <sequence value="1"/> <focal value="true"/> <coverage> <reference value="Coverage/9876B1"/> </coverage> </insurance> <item> <sequence value="1"/> <careTeamSequence value="1"/> <productOrService> <coding> <system value="http://hl7.org/fhir/ex-serviceproduct"/> <code value="exam"/> </coding> </productOrService> <servicedDate value="2014-08-16"/> <unitPrice> <value value="125.00"/> <currency value="USD"/> </unitPrice> <net> <value value="125.00"/> <currency value="USD"/> </net> <encounter> <reference value="Encounter/example"/> </encounter> </item> <total> <value value="125.00"/> <currency value="USD"/> </total>
</Claim>