<?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>