<Coverage xmlns="http://hl7.org/fhir"><id value="SP1234"/><text><status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of a Self Pay Agreement.</div></text><identifier><system value="http://hospitalx.com/selfpayagreement"/><value value="SP12345678"/></identifier><status value="active"/><kind value="self-pay"/><paymentBy><party><reference value="Patient/5"/></party></paymentBy><type><coding><system value="http://terminology.hl7.org/CodeSystem/coverage-selfpay"/><code value="pay"/><display value="PAY"/></coding></type><subscriber><reference value="Patient/5"/></subscriber><beneficiary><reference value="Patient/5"/></beneficiary><relationship><coding><code value="self"/></coding></relationship><period><end value="2012-03-17"/></period></Coverage>