DSTU2

This page is part of the FHIR Specification (v0.0.82: (v1.0.2: DSTU 1). 2). The current version which supercedes this version is 5.0.0 . For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

Explanationofbenefit-example.xml

Raw XML ( canonical form )

General Person Primary Coverage Example (id = "R3500")

Raw XML 

  
  
    
    
  
  
    
    
  
  
    
  
  
  
  
  
    
  
  
    
  

<ExplanationOfBenefit xmlns="http://hl7.org/fhir">
 <id value="R3500"/>

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


  <identifier>
    <system value="http://www.BenefitsInc.com/fhir/eob"/>
    <value value="987654321"/>
  </identifier>


  <request>
  <reference value="http://www.BenefitsInc.com/fhir/oralhealthclaim/15476332402"/>
  </request>

  
  <outcome value="complete"/>

  
  <disposition value="Claim settled as per contract."/>

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


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


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

 




</ExplanationOfBenefit>

</

ExplanationOfBenefit

>

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.