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

<id value="760151"/>

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

<identifier>
        <system value="http://happypharma.com/claim"/>
        <value value="7612345"/>
</identifier>

<status value="active"/>

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

<use value="complete"/>

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

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

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

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

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

<prescription>
  <reference value="http://pharmacy.org/MedicationRequest/AB1234G"/>
</prescription>

<originalPrescription>
  <reference value="http://pharmacy.org/MedicationRequest/AB1202B"/>
</originalPrescription>

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

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

<information>
        <sequence value="1"/>
        <category>
                <coding>
                        <code value="pharmacyrefill"/>
                </coding>
        </category>
        <code>
                <coding>
                        <system value="http://hl7.org/fhir/pharmacy-refill"/>
                        <code value="new"/>
                </coding>
        </code> 
</information>

<information>
        <sequence value="2"/>
        <category>
                <coding>
                        <code value="pharmacyinformation"/>
                </coding>
        </category>
        <code>
                <coding>
                        <system value="http://hl7.org/fhir/pharmacy-information"/>
                        <code value="refillsremaining"/>
                </coding>
        </code> 
        <valueQuantity>
                <value value="2"/>
        </valueQuantity>
</information>

<information>
        <sequence value="3"/>
        <category>
                <coding>
                        <code value="pharmacyinformation"/>
                </coding>
        </category>
        <code>
                <coding>
                        <system value="http://hl7.org/fhir/pharmacy-information"/>
                        <code value="dayssupply"/>
                </coding>
        </code> 
        <valueQuantity>
                <value value="90"/>
        </valueQuantity>
</information>

<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"/>
        <informationLinkId value="1"/>
        <informationLinkId value="2"/>
        <informationLinkId value="3"/>
        <!--  type=packagemedication  -->
        <service>
                <coding>
                        <system value="http://hl7.org/fhir/RxNorm"/>
                        <code value="562721"/> 
                        <display value="Alprazolam 0.25mg (Xanax)"/>
                </coding> 
        </service>
        <servicedDate value="2014-08-16"/>
        <quantity>
                <value value="90"/>
                <unit value="TAB"/>
                <system value="http://unitsofmeasure.org"/> <!--  UCUM  -->
                <code value="TAB"/>
        </quantity>
        <net>
                <value value="90.00"/>
                <system value="urn:iso:std:iso:4217"/>
                <code value="USD"/> 
        </net> 
        <detail>
                <sequence value="1"/>
                <!--  type=costitem  -->
                <service>
                        <coding>
                                <system value="http://hl7.org/fhir/ex-pharmaservice"/>
                                <code value="drugcost"/> 
                        </coding> 
                </service>
                <net>
                        <value value="45.00"/>
                        <system value="urn:iso:std:iso:4217"/>
                        <code value="USD"/> 
                </net> 
        </detail>
        <detail>
                <sequence value="2"/>
                <!--  type=costitem  -->
                <service>
                        <coding>
                                <system value="http://hl7.org/fhir/ex-pharmaservice"/>
                                <code value="markup"/> 
                        </coding> 
                </service>
                <net>
                        <value value="9.00"/>
                        <system value="urn:iso:std:iso:4217"/>
                        <code value="USD"/> 
                </net> 
        </detail>
        <detail>
                <sequence value="3"/>
                <!--  type=costitem  -->
                <service>
                        <coding>
                                <system value="http://hl7.org/fhir/ex-pharmaservice"/>
                                <code value="dispensefee"/> 
                        </coding> 
                </service>
                <net>
                        <value value="36.00"/>
                        <system value="urn:iso:std:iso:4217"/>
                        <code value="USD"/> 
                </net> 
        </detail>
</item>
<total>
        <value value="90.00"/>
        <system value="urn:iso:std:iso:4217"/>
        <code value="USD"/> 
</total>

</Claim>