<?xml version=“1.0” encoding=“UTF-8”?> <CoverageEligibilityRequest xmlns=“hl7.org/fhir”>

      <id value="52346"/>

      <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://happyvalley.com/coverageelegibilityrequest"/>
              <value value="52346"/>
      </identifier>

      <status value="active"/>

      <priority>
              <coding>
                      <code value="normal"/>
              </coding>
      </priority>

      <purpose value="validation"/>
      <purpose value="benefits"/>

      <patient>
              <reference value="Patient/pat1"/>
      </patient>

      <servicedDate value="2014-09-17"/> <!--  Anticipated service date  -->

      <created value="2014-08-16"/>

      <enterer>
              <identifier>
                      <system value="http://happyvalleyclinic.com/staff"/>
                      <value value="14"/>
              </identifier>
      </enterer>

      <provider>
              <reference value="Organization/1"/>
      </provider>

      <insurer>
              <reference value="Organization/2"/>
      </insurer>

      <facility>
              <identifier>
                      <system value="http://statecliniclicensor.com/clinicid"/>
                      <value value="G35B9"/>
              </identifier>
      </facility>

      <insurance>
              <coverage>
                      <reference value="Coverage/9876B1"/>
              </coverage>

              <businessArrangement value="NB8742"/>
      </insurance>

      <item>
              <category>
                      <coding>
                              <system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
                              <code value="69"/>
                              <display value="Maternity"/>
                      </coding>
              </category>
      </item>

</CoverageEligibilityRequest>