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

<id value="100155"/>

<text>
  <status value="generated"/>
  <div xmlns="http://www.w3.org/1999/xhtml">This example assumes a national health care scheme where patients, providers and organizations have known business identifiers.</div>
</text>

<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>

<identifier>
  <system value="http://happyvalley.com/claim"/>
  <value value="12347"/>
</identifier>

<status value="active"/>

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

<use value="complete"/>

<patient>
  <reference value="#patient-1"/>
</patient>

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

<insurer>
  <identifier>
    <system value="http://www.jurisdiction.com/insurers"/>
    <value value="123456"/>
      </identifier>
</insurer>

<organization>
      <identifier>
    <system value="http://www.jurisdiction.com/careorganizations"/>
    <value value="HOSP12345"/>
      </identifier>
</organization>

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

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

 <careTeam>
  <sequence value="1"/>
  <provider>
       <identifier>
    <system value="http://www.jurisdiction.com/providerId"/>
    <value value="MD98765"/>
       </identifier>
  </provider>
 </careTeam>

<diagnosis>
  <sequence value="1"/>
  <diagnosisCodeableConcept>
       <coding>
    <code value="123456"/>
   </coding>
      </diagnosisCodeableConcept>
</diagnosis>

<insurance>
  <sequence value="1"/>
  <focal value="true"/>
  <coverage>
        <reference value="http://www.jurisdiction.com/Coverage/123AB345"/>
  </coverage>
</insurance>

<item>
  <sequence value="1"/>
  <careTeamLinkId value="1"/>
  <service>
       <coding>
    <code value="1200"/>
   </coding>
      </service>
  <servicedDate 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>