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

<id value="960150"/>

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

<identifier>
        <system value="http://happyhospital.com/claim"/>
        <value value="9612345"/>
</identifier>

<status value="active"/>

<type>
        <coding>
                <system value="http://hl7.org/fhir/ex-claimtype"/>
                <code value="institutional"/>
        </coding>
</type>

<subType>
        <coding>
                <system value="http://hl7.org/fhir/ex-claimsubtype"/>
                <code value="emergency"/>
        </coding>
</subType> 

<use value="complete"/>

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

<created value="2014-08-16"/>

<enterer>
        <identifier>
                <system value="http://jurisdiction.org/facilities/HOSP1234/users"/>
                <value value="UC1234"/>
        </identifier>
</enterer>

<insurer>
        <reference value="Organization/2"/>
</insurer>

<organization>
        <reference value="Organization/1"/>
</organization>

<priority>
        <coding>
                <code value="normal"/>
        </coding>
</priority>

<payee>
        <type>
                <coding>
                        <code value="provider"/>
                </coding>
        </type>
</payee>

<facility>
        <identifier>
                <system value="http://jurisdiction.org/facilities"/>
                <value value="HOSP1234"/>
        </identifier>
</facility>

<careTeam>
        <sequence value="1"/>
        <provider>
                <reference value="Practitioner/example"/>
        </provider>
</careTeam>

<diagnosis>
        <sequence value="1"/>
        <diagnosisCodeableConcept>
                <coding>
                        <code value="654456"/>
                </coding>
        </diagnosisCodeableConcept>
</diagnosis>

<insurance>
        <sequence value="1"/>
        <focal value="true"/>
        <coverage>
                <reference value="Coverage/9876B1"/>
        </coverage>
</insurance>

<item>
        <sequence value="1"/>
        <careTeamLinkId value="1"/>
        <service>
                <coding>
                        <system value="http://hl7.org/fhir/ex-serviceproduct"/>
                        <code value="exam"/> 
                </coding>
        </service>
        <servicedDate value="2014-08-16"/>
        <unitPrice>
                <value value="125.00"/>
                <system value="urn:iso:std:iso:4217"/>
                <code value="USD"/> 
        </unitPrice> 
        <net>
                <value value="125.00"/>
                <system value="urn:iso:std:iso:4217"/>
                <code value="USD"/> 
        </net> 
        <encounter>
                <reference value="Encounter/example"/>
        </encounter>
</item>

<total>
        <value value="125.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/>  
</total>

</Claim>