{

"resourceType": "Claim",
"id": "100155",
"contained": [
  {
    "resourceType": "Patient",
    "id": "patient-1",
    "name": [
      {
        "use": "official",
        "family": "Donald",
        "given": [
          "Duck"
        ]
      }
    ],
    "gender": "male",
    "birthDate": "1986-05-17",
    "address": [
      {
        "use": "home",
        "line": [
          "1234 Main Street"
        ],
        "city": "Vancouver",
        "postalCode": "V2H1Y3",
        "country": "CAD"
      }
    ]
  }
],
"identifier": [
  {
    "system": "http://happyvalley.com/claim",
    "value": "12347"
  }
],
"status": "active",
"type": {
  "coding": [
    {
      "system": "http://terminology.hl7.org/CodeSystem/claim-type",
      "code": "oral"
    }
  ]
},
"use": "claim",
"patient": {
  "reference": "#patient-1"
},
"created": "2014-08-16",
"insurer": {
  "identifier": {
    "system": "http://www.jurisdiction.com/insurers",
    "value": "123456"
  }
},
"provider": {
  "identifier": {
    "system": "http://www.jurisdiction.com/careorganizations",
    "value": "HOSP12345"
  }
},
"priority": {
  "coding": [
    {
      "code": "normal"
    }
  ]
},
"payee": {
  "type": {
    "coding": [
      {
        "code": "provider"
      }
    ]
  }
},
"careTeam": [
  {
    "sequence": 1,
    "provider": {
      "identifier": {
        "system": "http://www.jurisdiction.com/providerId",
        "value": "MD98765"
      }
    }
  }
],
"diagnosis": [
  {
    "sequence": 1,
    "diagnosisCodeableConcept": {
      "coding": [
        {
          "code": "123456"
        }
      ]
    }
  }
],
"insurance": [
  {
    "sequence": 1,
    "focal": true,
    "coverage": {
      "reference": "http://www.jurisdiction.com/Coverage/123AB345"
    }
  }
],
"item": [
  {
    "sequence": 1,
    "careTeamSequence": [
      1
    ],
    "productOrService": {
      "coding": [
        {
          "code": "1200"
        }
      ]
    },
    "servicedDate": "2014-08-16",
    "unitPrice": {
      "value": 135.57,
      "currency": "USD"
    },
    "net": {
      "value": 135.57,
      "currency": "USD"
    }
  }
],
"meta": {
  "tag": [
    {
      "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
      "code": "HTEST",
      "display": "test health data"
    }
  ]
}

}