This page is part of the FHIR Specification (v1.1.0: STU 3 Ballot 1). 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

This is a frozen snapshot of the FHIR specification created for the purpose of balloting the GAO implementation Guide. It includes draft changes that may be part of the future DSTU 2.1 release but further change is expected. Readers should focus solely on the GAO implementation content, and FHIR DSTU 2 for other purposes.

Explanationofbenefit-example.xml

Raw XML (canonical form)

<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>

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.