<?xml version=“1.0” encoding=“UTF-8”?> <Claim xmlns=“hl7.org/fhir”>
<id value="100154"/> <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/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> <identifier> <system value="http://www.jurisdiction.com/nationalId"/> <value value="123AB345"/> </identifier> </patient> <created value="2014-08-16"/> <insurer> <identifier> <system value="http://www.jurisdiction.com/insurers"/> <value value="123456"/> </identifier> </insurer> <provider> <identifier> <system value="http://www.jurisdiction.com/careorganizations"/> <value value="HOSP12345"/> </identifier> </provider> <priority> <coding> <code value="normal"/> </coding> </priority> <payee> <type> <coding> <code value="provider"/> </coding> </type> </payee> <careTeam> <sequence value="1"/> <provider> <identifier> <system value="http://www.jurisdiction.com/providerId"/> <value value="MD98765"/> </identifier> </provider> </careTeam> <diagnosis> <sequence value="1"/> <diagnosisCodeableConcept> <coding> <code value="123456"/> </coding> </diagnosisCodeableConcept> </diagnosis> <insurance> <sequence value="1"/> <focal value="true"/> <coverage> <identifier> <system value="http://www.jurisdiction.com/nationalplan"/> <value value="123AB345"/> </identifier> </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>