2nd DSTU Draft For Comment

This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). 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

7.5.5 Resource ExplanationOfBenefit - Examples

Example Index:

General Person Primary Coverage ExampleXMLJSON

7.5.5.1 General-Primary

XML

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"><!-- Snipped for brevity --></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>

JSON

General Person Primary Coverage Example

Raw JSON (Canonical)

{
  "resourceType": "ExplanationOfBenefit",
  "id": "R3500",
  "text": {
    "status": "generated",
    "div": "<div>!-- Snipped for Brevity --></div>"
  },
  "identifier": [
    {
      "system": "http://www.BenefitsInc.com/fhir/eob",
      "value": "987654321"
    }
  ],
  "request": {
    "reference": "http://www.BenefitsInc.com/fhir/oralhealthclaim/15476332402"
  },
  "outcome": "complete",
  "disposition": "Claim settled as per contract.",
  "created": "2014-08-16",
  "organization": {
    "reference": "Organization/2"
  },
  "requestOrganization": {
    "reference": "Organization/1"
  }
}

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.