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

<id value="660150"/>

<text>
   <status value="generated"/>
   <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Vision Claim</div>
 </text>

 <type value="vision"/>

 <identifier>
   <system value="http://happysight.com/claim"/>
   <value value="6612345"/>
</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="654321"/>
         </diagnosis>
 </diagnosis>

<patient>
  <reference value="Patient/1"/>
</patient>

<coverage>
  <sequence value="1"/>
  <focal value="true"/>
  <coverage>
    <reference value="Coverage/9876B1"/>
  </coverage>
  <relationship>
    <code value="self"/>
  </relationship>
</coverage>

<item>
  <sequence value="1"/>
  <type>
    <code value="CSINV"/>
  </type>
  <provider>
    <reference value="Practitioner/example"/>
  </provider>
  <service>
    <system value="http://hl7.org/fhir/ex-visionservice"/>
    <code value="exam"/>
  </service>
  <serviceDate value="2014-08-16"/>
  <unitPrice>
     <value value="80.00"/>
         <system value="urn:iso:std:iso:4217"/>
     <code value="USD"/> 
  </unitPrice> 
  <net>
     <value value="80.00"/>
         <system value="urn:iso:std:iso:4217"/>
     <code value="USD"/> 
  </net> 
 </item>

</Claim>