<?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>