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

      <id value="100152"/>
      <meta>
  <security>
    <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
    <code value="HTEST"/>
    <display value="test health data"/>
  </security>
</meta>

      <contained>
              <Organization>
                      <id value="org-insurer"/>
                      <identifier>
                              <system value="http://www.bindb.com/bin"/>
                              <value value="123456"/>
                      </identifier>
              </Organization>
      </contained>

      <contained>
              <Organization>
                      <id value="org-org"/>
                      <identifier>
                              <system value="http://www.jurisdiction.com/oralhealthoffices"/>
                              <value value="3456"/>
                      </identifier>
              </Organization>
      </contained>

      <contained>
              <Practitioner>
                      <id value="provider-1"/>
                      <identifier>
                              <system value="http://www.jurisdiction.com/oralhealthproviders"/>
                              <value value="123456789"/>
                      </identifier>
              </Practitioner>
      </contained>

      <contained>
              <Patient>
                      <id value="patient-1"/>
                      <name>
                              <use value="official"/>
                              <family value="Donald"/>
                              <given value="Duck"/>
                      </name>
                      <gender value="male"/>
                      <birthDate value="1986-05-17"/>
                      <address>
                              <use value="home"/>
                              <line value="1234 Main Street"/>
                              <city value="Vancouver"/>
                              <postalCode value="V2H1Y3"/>
                              <country value="CAD"/>
                      </address>
              </Patient>
      </contained>

      <contained>
              <Coverage>
                      <id value="coverage-1"/>

                      <identifier>
                              <system value="http://benefitsinc.com/certificate"/>
                              <value value="12345"/>
                      </identifier>

                      <status value="active"/>

                      <type>
                              <coding>
                                      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
                                      <code value="EHCPOL"/>
                              </coding>
                      </type>

                      <subscriber>
                              <reference value="#patient-1"/>
                      </subscriber>

                      <beneficiary>
                              <reference value="#patient-1"/>
                      </beneficiary>
                      <dependent value="1"/>

                      <relationship>
                              <coding>
                                      <code value="self"/>
                              </coding>
                      </relationship>

                      <payor>
                              <identifier>
                                      <system value="http://www.bindb.com/bin"/>
                                      <value value="123456"/>
                              </identifier>
                      </payor>

                      <class>
                              <type>
                                      <coding>
                                              <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
                                              <code value="plan"/>
                                      </coding>
                              </type>
                              <value value="CBI35"/>
                              <name value="Corporate Baker's Inc. Plan#35"/>
                      </class>

                      <class>
                              <type>
                                      <coding>
                                              <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
                                              <code value="subplan"/>
                                      </coding>
                              </type>
                              <value value="123"/>
                              <name value="Trainee Part-time Benefits"/>
                      </class>

                      <class>
                              <type>
                                      <coding>
                                              <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
                                              <code value="sequence"/>
                                      </coding>
                              </type>
                              <value value="1"/>
                      </class>

              </Coverage>
      </contained>

      <identifier>
              <system value="http://happyvalley.com/claim"/>
              <value value="12347"/>
      </identifier>

      <status value="active"/>

      <type>
              <coding>
                      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
                      <code value="oral"/>
              </coding>
      </type>

      <use value="claim"/>

      <patient>
              <reference value="#patient-1"/>
      </patient>

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

      <insurer>
              <reference value="#org-insurer"/>
      </insurer>

      <provider>
              <reference value="#org-org"/>
      </provider>  

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

      <payee>
              <type>
                      <coding>
                              <code value="provider"/>
                      </coding>
              </type>
      </payee>

      <careTeam>
              <sequence value="1"/>
              <provider>
                      <reference value="#provider-1"/>
              </provider>
      </careTeam>

      <diagnosis>
              <sequence value="1"/>
              <diagnosisCodeableConcept>
                      <coding>
                              <code value="123456"/>
                      </coding>
              </diagnosisCodeableConcept>
      </diagnosis>

      <insurance>
              <sequence value="1"/>
              <focal value="true"/>
              <coverage>
                      <reference value="#coverage-1"/>
              </coverage>
      </insurance>

      <item>
              <sequence value="1"/>
              <careTeamSequence value="1"/>
              <productOrService>
                      <coding>
                              <code value="1200"/>
                      </coding>
              </productOrService>
              <servicedDate value="2014-08-16"/>
              <unitPrice>
                      <value value="135.57"/>
                      <currency value="USD"/>
              </unitPrice>
              <net>
                      <value value="135.57"/>
                      <currency value="USD"/>
              </net>
      </item>

</Claim>