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

<id value="100152"/>
<text>
  <status value="generated"/>
  <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Oral Health Claim</div>
</text>
<contained>
  <Organization>
    <id value="organization-1"/>
    <identifier>
      <system value="http://www.jurisdiction.com/oralhealthoffices"/>
      <value value="3456"/>
    </identifier>
  </Organization>
</contained>
<contained>
  <Organization>
    <id value="organization-2"/>
    <identifier>
      <system value="http://www.bindb.com/bin"/>
      <value value="123456"/>
    </identifier>
  </Organization>
</contained>
<contained>
  <Practitioner>
    <id value="practitioner-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"/>
    <issuer>
      <reference value="#organization-2"/>
    </issuer>
    <type>
      <system value="http://hl7.org/fhir/v3/ActCode"/>
      <code value="EHCPOL"/>
    </type>
    <identifier>
      <system value="http://benefitsinc.com/certificate"/>
      <value value="12345"/>
    </identifier>
    <plan value="CBI35"/>
    <subPlan value="123"/>
    <dependent value="1"/>
    <sequence value="1"/>
    <subscriber>
      <reference value="#patient-1"/>
    </subscriber>
  </Coverage>
</contained>
<type value="oral"/>
<identifier>
  <system value="http://happyvalley.com/claim"/>
  <value value="12347"/>
</identifier>
<created value="2014-08-16"/>
<target>
  <reference value="#organization-2"/>
</target>
<organization>
  <reference value="#organization-1"/>
</organization>
<use value="complete"/>
<priority>
  <code value="normal"/>
</priority>
<payee>
  <type>
    <code value="provider"/>
  </type>
</payee>
<diagnosis>
  <sequence value="1"/>
  <diagnosis>
    <code value="123456"/>
  </diagnosis>
</diagnosis>
<patient>
  <reference value="#patient-1"/>
</patient>
<coverage>
  <sequence value="1"/>
  <focal value="true"/>
  <coverage>
    <reference value="#coverage-1"/>
  </coverage>
  <relationship>
    <code value="self"/>
  </relationship>
</coverage>
<item>
  <sequence value="1"/>
  <type>
    <code value="CSINV"/>
  </type>
  <provider>
    <reference value="#practitioner-1"/>
  </provider>
  <service>
    <code value="1200"/>
  </service>
  <serviceDate value="2014-08-16"/>
  <unitPrice>
    <value value="135.57"/>
    <system value="urn:iso:std:iso:4217"/>
    <code value="USD"/>
  </unitPrice>
  <net>
    <value value="135.57"/>
    <system value="urn:iso:std:iso:4217"/>
    <code value="USD"/>
  </net>
</item>

</Claim>