DSTU2 QA Preview

This page is part of the FHIR Specification (v1.0.0: DSTU 2 Ballot 3). 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>

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.