{

"resourceType": "Claim",
"id": "760152",
"text": {
  "status": "generated",
  "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the Pharmacy Claim</div>"
},
"identifier": [
  {
    "system": "http://happypharma.com/claim",
    "value": "7612345"
  }
],
"status": "active",
"type": {
  "coding": [
    {
      "system": "http://hl7.org/fhir/ex-claimtype",
      "code": "pharmacy"
    }
  ]
},
"use": "complete",
"patient": {
  "reference": "Patient/1"
},
"created": "2014-08-16",
"insurer": {
  "reference": "Organization/2"
},
"organization": {
  "reference": "Organization/1"
},
"priority": {
  "coding": [
    {
      "code": "stat"
    }
  ]
},
"payee": {
  "type": {
    "coding": [
      {
        "code": "provider"
      }
    ]
  }
},
"careTeam": [
  {
    "sequence": 1,
    "provider": {
      "reference": "Practitioner/example"
    }
  }
],
"information": [
  {
    "sequence": 1,
    "category": {
      "coding": [
        {
          "code": "pharmacyrefill"
        }
      ]
    },
    "code": {
      "coding": [
        {
          "system": "http://hl7.org/fhir/pharmacy-refill",
          "code": "new"
        }
      ]
    }
  },
  {
    "sequence": 2,
    "category": {
      "coding": [
        {
          "code": "pharmacyinformation"
        }
      ]
    },
    "code": {
      "coding": [
        {
          "system": "http://hl7.org/fhir/pharmacy-information",
          "code": "refillsremaining"
        }
      ]
    },
    "valueQuantity": {
      "value": 0
    }
  },
  {
    "sequence": 3,
    "category": {
      "coding": [
        {
          "code": "pharmacyinformation"
        }
      ]
    },
    "code": {
      "coding": [
        {
          "system": "http://hl7.org/fhir/pharmacy-information",
          "code": "dayssupply"
        }
      ]
    },
    "valueQuantity": {
      "value": 10
    }
  },
  {
    "sequence": 4,
    "category": {
      "coding": [
        {
          "code": "pharmacy"
        }
      ]
    },
    "code": {
      "coding": [
        {
          "system": "http://hl7.org/fhir/pharmacy-form",
          "code": "capsule"
        }
      ]
    }
  }
],
"diagnosis": [
  {
    "sequence": 1,
    "diagnosisCodeableConcept": {
      "coding": [
        {
          "code": "654456"
        }
      ]
    }
  }
],
"insurance": [
  {
    "sequence": 1,
    "focal": true,
    "coverage": {
      "reference": "Coverage/9876B1"
    }
  }
],
"item": [
  {
    "sequence": 1,
    "careTeamLinkId": [
      1
    ],
    "informationLinkId": [
      1,
      2,
      3,
      4
    ],
    "service": {
      "coding": [
        {
          "system": "http://localdruglist.org",
          "code": "compound",
          "display": "Custom compound"
        }
      ]
    },
    "servicedDate": "2014-08-16",
    "quantity": {
      "value": 30,
      "unit": "TAB",
      "system": "http://unitsofmeasure.org",
      "code": "TAB"
    },
    "net": {
      "value": 155.00,
      "system": "urn:iso:std:iso:4217",
      "code": "USD"
    },
    "detail": [
      {
        "sequence": 1,
        "service": {
          "coding": [
            {
              "system": "http://localdruglist.org",
              "code": "44001",
              "display": "Acetaminophen 250mg"
            }
          ]
        },
        "quantity": {
          "value": 250,
          "unit": "mg"
        },
        "net": {
          "value": 20.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "subDetail": [
          {
            "sequence": 1,
            "service": {
              "coding": [
                {
                  "system": "http://hl7.org/fhir/ex-pharmaservice",
                  "code": "drugcost"
                }
              ]
            },
            "net": {
              "value": 20.00,
              "system": "urn:iso:std:iso:4217",
              "code": "USD"
            }
          }
        ]
      },
      {
        "sequence": 2,
        "service": {
          "coding": [
            {
              "system": "http://localdruglist.org",
              "code": "44035",
              "display": "Phenacetin 50mg"
            }
          ]
        },
        "quantity": {
          "value": 50,
          "unit": "mg"
        },
        "net": {
          "value": 25.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "subDetail": [
          {
            "sequence": 1,
            "service": {
              "coding": [
                {
                  "system": "http://hl7.org/fhir/ex-pharmaservice",
                  "code": "drugcost"
                }
              ]
            },
            "net": {
              "value": 25.00,
              "system": "urn:iso:std:iso:4217",
              "code": "USD"
            }
          }
        ]
      },
      {
        "sequence": 3,
        "service": {
          "coding": [
            {
              "system": "http://localdruglist.org",
              "code": "44057",
              "display": "Codeine 25mg"
            }
          ]
        },
        "quantity": {
          "value": 25,
          "unit": "mg"
        },
        "net": {
          "value": 28.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "subDetail": [
          {
            "sequence": 1,
            "service": {
              "coding": [
                {
                  "system": "http://hl7.org/fhir/ex-pharmaservice",
                  "code": "drugcost"
                }
              ]
            },
            "net": {
              "value": 28.00,
              "system": "urn:iso:std:iso:4217",
              "code": "USD"
            }
          }
        ]
      },
      {
        "sequence": 2,
        "service": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/ex-pharmaservice",
              "code": "markup"
            }
          ]
        },
        "net": {
          "value": 22.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      },
      {
        "sequence": 3,
        "service": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/ex-pharmaservice",
              "code": "compoundfee"
            }
          ]
        },
        "net": {
          "value": 60.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    ]
  }
],
"total": {
  "value": 155.00,
  "system": "urn:iso:std:iso:4217",
  "code": "USD"
}

}