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

<id value="960151"/>

<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="96123451"/>
</identifier>

<status value="active"/>

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

<use value="complete"/>

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

<billablePeriod>
  <start value="2014-08-15"/>
  <end value="2014-08-16"/>
</billablePeriod>

<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>

<provider>
  <identifier>
    <system value="http://npid.org/providerid"/>
    <value value="NJ12345"/>
  </identifier>
</provider>

<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>
  <responsible value="true"/>
  <role>
    <coding>
      <system value="http://hl7.org/fhir/claim-careteamrole"/>
      <code value="primary"/>
    </coding>
  </role>
  <qualification>
    <coding>
      <system value="http://hl7.org/fhir/provider-qualification"/>
      <code value="physician"/>
    </coding>
  </qualification>
</careTeam>

<diagnosis>
  <sequence value="1"/>
  <diagnosisCodeableConcept>
    <coding>
      <code value="654456"/>
    </coding>
  </diagnosisCodeableConcept>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/ex-diagnosistype"/>
      <code value="admitting"/>
    </coding>
  </type>
  <packageCode>
    <coding>
      <system value="http://hl7.org/fhir/ex-diagnosisrelatedgroup"/>
      <code value="400"/>
      <display value="Head trauma - concussion"/>
    </coding>
  </packageCode>
</diagnosis>

<insurance>
  <sequence value="1"/>
  <focal value="true"/>
  <coverage>
    <reference value="Coverage/9876B1"/>
  </coverage>
  <businessArrangement value="BA987123"/>
  <preAuthRef value="PA2014G56473"/>
</insurance>

<accident>
  <date value="2014-07-09"/>
  <type>
    <coding>
      <system value="http://hl7.org/fhir/v3/ActIncidentCode"/>
      <code value="SPT"/>
      <display value="Sporting Accident"/>
    </coding>
  </type>
  <locationAddress>
    <text value="Grouse Mountain Ski Hill"/>
  </locationAddress>
</accident>

<employmentImpacted>
  <start value="2014-08-16"/>
  <end value="2014-08-16"/>
</employmentImpacted>

<hospitalization>
  <start value="2014-08-15"/>
  <end value="2014-08-16"/>
</hospitalization>

<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> 
</item>

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

</Claim>