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

Reversal-example.xml

Raw XML (canonical form)

Claim Reversal Example (id = "87654")

Raw XML

<Reversal xmlns="http://hl7.org/fhir">
  <id value="87654"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><!-- Snipped for brevity --></div>
  </text>
  <identifier>
    <system value="http://happyvalley.com/reversal"/>
    <value value="76543"/>
  </identifier>
  <created value="2014-08-16"/>
  <organization>
    <reference value="Organization/1"/>
  </organization>
  <request>
    <reference value="http://BenefitsInc.com/fhir/oralhealthclaim/12345"/>
  </request>
  <coverage>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
    <relationship>
      <code value="self"/>
    </relationship>
  </coverage>
  <nullify value="false"/>
</Reversal>

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.