{

"resourceType": "Claim",
"id": "660151",
"text": {
  "status": "generated",
  "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Vision Claim for Glasses</div>"
},
"identifier": [
  {
    "system": "http://happysight.com/claim",
    "value": "6612346"
  }
],
"status": "active",
"type": {
  "coding": [
    {
      "system": "http://hl7.org/fhir/ex-claimtype",
      "code": "vision"
    }
  ]
},
"use": "complete",
"patient": {
  "reference": "Patient/1"
},
"created": "2014-08-16",
"insurer": {
  "reference": "Organization/2"
},
"organization": {
  "reference": "Organization/1"
},
"priority": {
  "coding": [
    {
      "code": "normal"
    }
  ]
},
"prescription": {
  "reference": "http://www.optdocs.com/VisionPrescription/12345"
},
"payee": {
  "type": {
    "coding": [
      {
        "code": "provider"
      }
    ]
  }
},
"careTeam": [
  {
    "sequence": 1,
    "provider": {
      "reference": "Practitioner/example"
    }
  }
],
"diagnosis": [
  {
    "sequence": 1,
    "diagnosisCodeableConcept": {
      "coding": [
        {
          "code": "654321"
        }
      ]
    }
  }
],
"insurance": [
  {
    "sequence": 1,
    "focal": true,
    "coverage": {
      "reference": "Coverage/9876B1"
    }
  }
],
"item": [
  {
    "sequence": 1,
    "careTeamLinkId": [
      1
    ],
    "service": {
      "coding": [
        {
          "system": "http://hl7.org/fhir/ex-visionservice",
          "code": "glasses"
        }
      ]
    },
    "servicedDate": "2014-08-16",
    "unitPrice": {
      "value": 214.00,
      "system": "urn:iso:std:iso:4217",
      "code": "USD"
    },
    "net": {
      "value": 214.00,
      "system": "urn:iso:std:iso:4217",
      "code": "USD"
    },
    "detail": [
      {
        "sequence": 1,
        "service": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/ex-visionservice",
              "code": "frame"
            }
          ]
        },
        "unitPrice": {
          "value": 100.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "net": {
          "value": 100.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      },
      {
        "sequence": 2,
        "service": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/ex-visionservice",
              "code": "lens"
            }
          ]
        },
        "quantity": {
          "value": 2
        },
        "unitPrice": {
          "value": 50.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "net": {
          "value": 100.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      },
      {
        "sequence": 3,
        "service": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/ex-visionservice",
              "code": "fst"
            }
          ]
        },
        "unitPrice": {
          "value": 200.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "factor": 0.07,
        "net": {
          "value": 14.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    ]
  }
]

}