This page is part of the FHIR Specification (v0.0.82: DSTU 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

Explanationofbenefit-example.json

Raw JSON (canonical form)

General Person Primary Coverage Example

{
  "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.