Eligibilityrequest-example-2.xml

Primary Coverage specifying Benefit Example (id = "52346")

<EligibilityRequest xmlns="http://hl7.org/fhir">
  <id value="52346"/> 

  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the EligibilityRequest</div> 
  </text> 

  <identifier> 
    <system value="http://happyvalley.com/elegibilityrequest"/> 
    <value value="52346"/> 
  </identifier> 

  <status value="active"/> 

  <priority> 
    <coding> 
      <code value="normal"/> 
    </coding> 
  </priority> 

  <patient> 
    <reference value="Patient/pat1"/> 
  </patient> 

  <servicedDate value="2014-09-17"/>  <!--   Anticipated service date   -->

  <created value="2014-08-16"/> 

  <enterer> 
    <identifier> 
      <system value="http://happyvalleyclinic.com/staff"/> 
      <value value="14"/> 
    </identifier> 
  </enterer> 

  <provider> 
    <identifier> 
      <system value="http://happyvalleyclinic.com/staff"/> 
      <value value="18"/> 
    </identifier> 
  </provider> 

  <organization> 
    <reference value="Organization/1"/> 
  </organization> 

  <insurer> 
    <reference value="Organization/2"/> 
  </insurer> 

  <facility> 
    <identifier> 
      <system value="http://statecliniclicensor.com/clinicid"/> 
      <value value="G35B9"/> 
    </identifier> 
  </facility> 

  <coverage> 
    <reference value="Coverage/9876B1"/> 
  </coverage> 

  <businessArrangement value="NB8742"/> 

  <benefitCategory> 
    <coding> 
      <system value="http://hl7.org/fhir/benefit-category"/> 
      <code value="medical"/> 
    </coding> 
  </benefitCategory> 

  <benefitSubCategory> 
    <coding> 
      <system value="http://hl7.org/fhir/benefit-subcategory"/> 
      <code value="69"/> 
      <display value="Maternity"/> 
    </coding> 
  </benefitSubCategory> 


</EligibilityRequest>