<?xml version="1.0" encoding="UTF-8"?>

<CoverageEligibilityRequest 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 CoverageEligibilityRequest</div>
  </text>
  <identifier>
    <system value="http://happyvalley.com/coverageelegibilityrequest"/>
    <value value="52346"/>
  </identifier>
  <status value="active"/>
  <priority>
    <coding>
      <code value="normal"/>
    </coding>
  </priority>
  <purpose value="validation"/>
  <purpose value="benefits"/>
  <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>
    <reference value="Organization/1"/>
  </provider>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <facility>
    <identifier>
      <system value="http://statecliniclicensor.com/clinicid"/>
      <value value="G35B9"/>
    </identifier>
  </facility>
  <insurance>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
    <businessArrangement value="NB8742"/>
  </insurance>
  <item>
    <category>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
        <code value="69"/>
        <display value="Maternity"/>
      </coding>
    </category>
  </item>
</CoverageEligibilityRequest>