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

<id value="660150"/>

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

 <identifier>
   <system value="http://happysight.com/claim"/>
   <value value="6612345"/>
</identifier>

 <status value="active"/>

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

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

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

 <diagnosis>
   <sequence value="1"/>
       <diagnosisCodeableConcept>
        <coding>
         <code value="654321"/>
    </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-visionservice"/>
    <code value="exam"/>
       </coding>
  </service>
  <servicedDate value="2014-08-16"/>
  <unitPrice>
     <value value="80.00"/>
         <system value="urn:iso:std:iso:4217"/>
     <code value="USD"/> 
  </unitPrice> 
  <net>
     <value value="80.00"/>
         <system value="urn:iso:std:iso:4217"/>
     <code value="USD"/> 
  </net> 
 </item>

</Claim>