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: Coverage For Patient 3 - Example - XML Representation

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="3"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2019-05-06T03:04:12.348-04:00"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the coverage</div>
  </text>
  <extension
             url="http://hl7.org/fhir/us/davinci-atr/StructureDefinition/ext-insuranceProductType">
    <valueCodeableConcept>
      <coding>
        <system
                value="http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/InsuranceProductTypeCS"/>
        <code value="ihs"/>
        <display value="Indian Health Service"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
        <display value="Member Number"/>
      </coding>
    </type>
    <system value="https://sitenv.org"/>
    <value value="123456"/>
  </identifier>
  <status value="active"/>
  <policyHolder>
    <reference value="RelatedPerson/1"/>
  </policyHolder>
  <subscriber>
    <reference value="RelatedPerson/1"/>
  </subscriber>
  <subscriberId value="AB3658"/>
  <beneficiary>
    <reference value="Patient/3"/>
  </beneficiary>
  <dependent value="01"/>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="spouse"/>
      <display value="Spouse"/>
    </coding>
  </relationship>
  <period>
    <start value="2013-05-23"/>
    <end value="2014-05-23"/>
  </period>
  <payor>
    <reference value="Organization/2"/>
  </payor>
  <class>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
        <code value="plan"/>
      </coding>
    </type>
    <value value="B37FC"/>
  </class>
</Coverage>