Belgian MyCareNet eAttestation Profiles
1.0.0 - STU Belgium flag

Belgian MyCareNet eAttestation Profiles, published by eHealth Platform. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/eattestation/ and changes regularly. See the Directory of published versions

: ex07 - XML Representation

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<Bundle xmlns="http://hl7.org/fhir">
  <id value="ex07"/>
  <meta>
    <profile
             value="https://www.ehealth.fgov.be/standards/fhir/eattestation/StructureDefinition/be-eattestation-request"/>
  </meta>
  <type value="message"/>
  <timestamp value="2015-07-14T11:15:33+02:00"/>
  <entry>
    <fullUrl value="urn:uuid:267b18ce-3d37-4581-9baa-6fada338038b"/>
    <resource>
      <MessageHeader>
        <id value="267b18ce-3d37-4581-9baa-6fada338038b"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-messageheader"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="MessageHeader_267b18ce-3d37-4581-9baa-6fada338038b"> </a><p><b>Generated Narrative: MessageHeader</b><a name="267b18ce-3d37-4581-9baa-6fada338038b"> </a><a name="hc267b18ce-3d37-4581-9baa-6fada338038b"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource MessageHeader &quot;267b18ce-3d37-4581-9baa-6fada338038b&quot; </p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/hl7-be/mycarenet//StructureDefinition-be-messageheader.html">MyCareNet MessageHeader BE profile</a></p></div><p><b>event</b>: eattest-create (Details: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/message-events code eattest-create = 'eattest-create', stated as 'null')</p><h3>Destinations</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td style="display: none">*</td><td>MyCareNet</td><td><code>urn:be:fgov:kbo-bce:organization:cbe-number:0820563481</code></td></tr></table><p><b>sender</b>: <a href="#Organization_e2c6f73a-74d8-40f2-af0b-a61ad20c53d4">See above (urn:uuid:e2c6f73a-74d8-40f2-af0b-a61ad20c53d4)</a></p><h3>Sources</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Endpoint</b></td></tr><tr><td style="display: none">*</td><td><code>urn:be:fgov:ehealth:1.0:hospital:nihii-number:71040622000</code></td></tr></table><p><b>focus</b>: <a href="#Claim_e85173bc-6f0d-480b-a2cd-2b70d9ffff7a">See above (urn:uuid:e85173bc-6f0d-480b-a2cd-2b70d9ffff7a)</a></p></div>
        </text>
        <eventCoding>
          <system
                  value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/message-events"/>
          <code value="eattest-create"/>
        </eventCoding>
        <destination>
          <name value="MyCareNet"/>
          <endpoint
                    value="urn:be:fgov:kbo-bce:organization:cbe-number:0820563481"/>
        </destination>
        <sender>
          <!--  serviceProvider  -->
          <reference value="urn:uuid:e2c6f73a-74d8-40f2-af0b-a61ad20c53d4"/>
        </sender>
        <source>
          <endpoint
                    value="urn:be:fgov:ehealth:1.0:hospital:nihii-number:71040622000"/>
        </source>
        <focus>
          <reference value="urn:uuid:e85173bc-6f0d-480b-a2cd-2b70d9ffff7a"/>
        </focus>
      </MessageHeader>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:e2c6f73a-74d8-40f2-af0b-a61ad20c53d4"/>
    <resource>
      <Organization>
        <id value="e2c6f73a-74d8-40f2-af0b-a61ad20c53d4"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_e2c6f73a-74d8-40f2-af0b-a61ad20c53d4"> </a><p><b>Generated Narrative: Organization</b><a name="e2c6f73a-74d8-40f2-af0b-a61ad20c53d4"> </a><a name="hce2c6f73a-74d8-40f2-af0b-a61ad20c53d4"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Organization &quot;e2c6f73a-74d8-40f2-af0b-a61ad20c53d4&quot; </p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/hl7-be/core//StructureDefinition-be-organization.html">BeOrganization</a></p></div><p><b>identifier</b>: <a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-nihdi.html" title="RIZIV/INAMI">BeNIHDINamingSystem</a>/71040622000, <a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-cbe.html" title="BCE/KBO">BeCBENamingSystem</a>/0941792893</p><p><b>type</b>: hospital <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/core//CodeSystem-cd-hcparty.html">BeCdHcParty</a>#orghospital)</span></p></div>
        </text>
        <identifier>
          <system
                  value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
          <value value="71040622000"/>
        </identifier>
        <identifier>
          <system
                  value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/cbe"/>
          <value value="0941792893"/>
        </identifier>
        <type>
          <coding>
            <system
                    value="https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"/>
            <code value="orghospital"/>
          </coding>
        </type>
      </Organization>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834"/>
    <resource>
      <PractitionerRole>
        <id value="62c7bfad-0cb3-4a39-9abb-3a62e06de834"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="PractitionerRole_62c7bfad-0cb3-4a39-9abb-3a62e06de834"> </a><p><b>Generated Narrative: PractitionerRole</b><a name="62c7bfad-0cb3-4a39-9abb-3a62e06de834"> </a><a name="hc62c7bfad-0cb3-4a39-9abb-3a62e06de834"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource PractitionerRole &quot;62c7bfad-0cb3-4a39-9abb-3a62e06de834&quot; </p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/hl7-be/core//StructureDefinition-be-practitionerrole.html">BePractitionerRole</a></p></div><p><b>practitioner</b>: <a href="#Practitioner_03972cc4-d781-4285-8d79-0f05810e1931">See above (urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931)</a></p><p><b>code</b>: physician <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/core//CodeSystem-cd-hcparty.html">BeCdHcParty</a>#persphysician)</span></p></div>
        </text>
        <practitioner>
          <reference value="urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931"/>
        </practitioner>
        <code>
          <coding>
            <system
                    value="https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"/>
            <code value="persphysician"/>
          </coding>
        </code>
      </PractitionerRole>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931"/>
    <resource>
      <Practitioner>
        <id value="03972cc4-d781-4285-8d79-0f05810e1931"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitioner"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_03972cc4-d781-4285-8d79-0f05810e1931"> </a><p><b>Generated Narrative: Practitioner</b><a name="03972cc4-d781-4285-8d79-0f05810e1931"> </a><a name="hc03972cc4-d781-4285-8d79-0f05810e1931"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Practitioner &quot;03972cc4-d781-4285-8d79-0f05810e1931&quot; </p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/hl7-be/core//StructureDefinition-be-practitioner.html">BePractitioner</a></p></div><p><b>identifier</b>: <a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-nihdi.html" title="RIZIV/INAMI">BeNIHDINamingSystem</a>/12898723580</p><p><b>name</b>: John Smith </p></div>
        </text>
        <identifier>
          <!--  serviceProvider for attest (and in this case also the provider for item) -->
          <system
                  value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
          <value value="12898723580"/>
        </identifier>
        <name>
          <family value="Smith"/>
          <given value="John"/>
        </name>
      </Practitioner>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686"/>
    <resource>
      <Patient>
        <id value="a52efcb6-1f81-4333-a115-d45bd3183686"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_a52efcb6-1f81-4333-a115-d45bd3183686"> </a><p><b>Generated Narrative: Patient</b><a name="a52efcb6-1f81-4333-a115-d45bd3183686"> </a><a name="hca52efcb6-1f81-4333-a115-d45bd3183686"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Patient &quot;a52efcb6-1f81-4333-a115-d45bd3183686&quot; </p><p style="margin-bottom: 0px">Profile: <a href="https://build.fhir.org/ig/hl7-be/core//StructureDefinition-be-patient.html">BePatient</a></p></div><p><b>identifier</b>: <a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-ssin.html" title="NISS/INSZ">BeSSINNamingSystem</a>/73031805784</p><p><b>name</b>: Jean Dupont </p><p><b>gender</b>: male</p></div>
        </text>
        <identifier>
          <!--  patient  -->
          <system
                  value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin"/>
          <value value="73031805784"/>
        </identifier>
        <name>
          <family value="Dupont"/>
          <given value="Jean"/>
        </name>
        <gender value="male"/>
      </Patient>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:e85173bc-6f0d-480b-a2cd-2b70d9ffff7a"/>
    <resource>
      <Claim>
        <id value="e85173bc-6f0d-480b-a2cd-2b70d9ffff7a"/>
        <meta>
          <!--  new profile to create for the request  -->
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/eattestation/StructureDefinition/be-eattestation-claim"/>
        </meta>
        <text>
          <status value="extensions"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><a name="Claim_e85173bc-6f0d-480b-a2cd-2b70d9ffff7a"> </a><p><b>Generated Narrative: Claim</b><a name="e85173bc-6f0d-480b-a2cd-2b70d9ffff7a"> </a><a name="hce85173bc-6f0d-480b-a2cd-2b70d9ffff7a"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Claim &quot;e85173bc-6f0d-480b-a2cd-2b70d9ffff7a&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-be-eattestation-claim.html">MyCareNet eAttestation Claim BE profile</a></p></div><p><b>BeExtEAttestationSupplement</b>: <span title="Euro">€2.00</span> (EUR)</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claim-type.html">Claim Type Codes</a>#professional)</span></p><p><b>subType</b>: specializedmedicine <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-be-cs-eattestation-types.html">Attestation types</a>#specializedmedicine)</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href="#Patient_a52efcb6-1f81-4333-a115-d45bd3183686">See above (urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686)</a></p><p><b>created</b>: 2015-07-14 11:15:30+0200</p><p><b>enterer</b>: <a href="#PractitionerRole_62c7bfad-0cb3-4a39-9abb-3a62e06de834">See above (urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834)</a></p><p><b>provider</b>: <a href="#PractitionerRole_62c7bfad-0cb3-4a39-9abb-3a62e06de834">See above (urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834)</a></p><p><b>priority</b>: Immediate <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-processpriority.html">Process Priority Codes</a>#stat)</span></p><h3>Payees</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td style="display: none">*</td><td>Subscriber <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-payeetype.html">Payee Type Codes</a>#subscriber)</span></td><td><a href="#Patient_a52efcb6-1f81-4333-a115-d45bd3183686">See above (urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686)</a></td></tr></table><h3>CareTeams</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Role</b></td><td><b>Qualification</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><span><a href="https://build.fhir.org/ig/hl7-be/core//NamingSystem-be-nihdi.html" title="RIZIV/INAMI">BeNIHDINamingSystem</a>/12471131580</span></td><td>Primary provider <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claimcareteamrole.html">Claim Care Team Role Codes</a>#primary)</span></td><td>physician <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/core//CodeSystem-cd-hcparty.html">BeCdHcParty</a>#persphysician)</span></td></tr></table><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: Information <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claiminformationcategory.html">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: 0070 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-treatment-reason.html">Treatment Reason</a>#0070)</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: Information <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.3.0/CodeSystem-claiminformationcategory.html">Claim Information Category Codes</a>#info)</span></p><p><b>code</b>: 0 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-claim-norm-code.html">Claim Norm Code</a>#0)</span></p></blockquote><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>true</td><td><span>: use of mandatory insurance coverage, no further details provided here.</span></td></tr></table><blockquote><p><b>item</b></p><p><b>BeExtEAttestationItemSupplement</b>: <span title="Euro">€2.00</span> (EUR)</p><blockquote><p><b>BeExtPatientIdentityDocument</b></p><blockquote><p><b>url</b></p><code>readingDate</code></blockquote><p><b>value</b>: 2017-01-27</p><blockquote><p><b>url</b></p><code>readingTime</code></blockquote><p><b>value</b>: 11:20:00</p><blockquote><p><b>url</b></p><code>entryType</code></blockquote><p><b>value</b>: 4 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-id-doc-input-type.html">Id Doc Input Type</a>#4)</span></p><blockquote><p><b>url</b></p><code>reasonManual</code></blockquote><p><b>value</b>: 2 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-id-doc-manual-input-justification.html">Id Doc Manual Input Justification</a>#2)</span></p><blockquote><p><b>url</b></p><code>medium</code></blockquote><p><b>value</b>: 1 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://build.fhir.org/ig/hl7-be/nihdi-terminology//CodeSystem-be-cs-id-doc-media-type.html">Id Doc Media Type</a>#1)</span></p><blockquote><p><b>url</b></p><code>serialNumber</code></blockquote><p><b>value</b>: actual cardnumber as string</p></blockquote><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>informationSequence</b>: 2</p><p><b>productOrService</b>: 102034 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (be-ns-nihdi-nomenclature#102034)</span></p><p><b>serviced</b>: 2017-01-27</p><p><b>quantity</b>: 1</p><h3>UnitPrices</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>38.86</td><td>EUR</td></tr></table><h3>Nets</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>38.86</td><td>EUR</td></tr></table></blockquote><h3>Totals</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style="display: none">*</td><td>38.86</td><td>EUR</td></tr></table></div>
        </text>
        <extension
                   url="https://www.ehealth.fgov.be/standards/fhir/eattestation/StructureDefinition/be-ext-eattestation-supplement">
          <!--  supplement for eattest  -->
          <valueMoney>
            <value value="2.00"/>
            <currency value="EUR"/>
          </valueMoney>
        </extension>
        <status value="active"/>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
            <code value="professional"/>
          </coding>
        </type>
        <subType>
          <!--  attestationType  -->
          <coding>
            <system
                    value="https://www.ehealth.fgov.be/standards/fhir/eattestation/CodeSystem/be-cs-eattestation-types"/>
            <code value="specializedmedicine"/>
          </coding>
        </subType>
        <use value="claim"/>
        <patient>
          <reference value="urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686"/>
        </patient>
        <created value="2015-07-14T11:15:30+02:00"/>
        <enterer>
          <reference value="urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834"/>
        </enterer>
        <provider>
          <!--  provider for item  -->
          <reference value="urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834"/>
        </provider>
        <priority>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/processpriority"/>
            <code value="stat"/>
          </coding>
        </priority>
        <payee>
          <type>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/payeetype"/>
              <code value="subscriber"/>
            </coding>
          </type>
          <party>
            <reference value="urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686"/>
          </party>
        </payee>
        <careTeam>
          <!--  service - Provider  -->
          <sequence value="1"/>
          <provider>
            <identifier>
              <system
                      value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
              <value value="12471131580"/>
            </identifier>
          </provider>
          <role>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/claimcareteamrole"/>
              <code value="primary"/>
            </coding>
          </role>
          <qualification>
            <coding>
              <system
                      value="https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"/>
              <code value="persphysician"/>
            </coding>
          </qualification>
        </careTeam>
        <supportingInfo>
          <!--  treatmentCauses for attest -->
          <sequence value="1"/>
          <category>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
              <code value="info"/>
            </coding>
          </category>
          <code>
            <coding>
              <system
                      value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-treatment-reason"/>
              <code value="0070"/>
            </coding>
          </code>
        </supportingInfo>
        <supportingInfo>
          <!--  standard (claim norm) for item  -->
          <sequence value="2"/>
          <category>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
              <code value="info"/>
            </coding>
          </category>
          <code>
            <coding>
              <system
                      value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-claim-norm-code"/>
              <code value="0"/>
            </coding>
          </code>
        </supportingInfo>
        <insurance>
          <sequence value="1"/>
          <focal value="true"/>
          <coverage>
            <display
                     value="use of mandatory insurance coverage, no further details provided here."/>
          </coverage>
        </insurance>
        <item>
          <extension
                     url="https://www.ehealth.fgov.be/standards/fhir/eattestation/StructureDefinition/be-ext-eattestation-item-supplement">
            <!--  supplement for item  -->
            <valueMoney>
              <value value="2.00"/>
              <currency value="EUR"/>
            </valueMoney>
          </extension>
          <extension
                     url="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/StructureDefinition/be-ext-patientidentitydocument">
            <!--  patientIdentityDocument for item  -->
            <extension url="readingDate">
              <valueDate value="2017-01-27"/>
            </extension>
            <extension url="readingTime">
              <valueTime value="11:20:00"/>
            </extension>
            <extension url="entryType">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-id-doc-input-type"/>
                  <code value="4"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <extension url="reasonManual">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-id-doc-manual-input-justification"/>
                  <code value="2"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <extension url="medium">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="https://www.ehealth.fgov.be/standards/fhir/nihdi-terminology/CodeSystem/be-cs-id-doc-media-type"/>
                  <code value="1"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <extension url="serialNumber">
              <valueString value="actual cardnumber as string"/>
            </extension>
          </extension>
          <sequence value="1"/>
          <careTeamSequence value="1"/>
          <informationSequence value="2"/>
          <productOrService>
            <!--  identifier for item  -->
            <coding>
              <system
                      value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/be-ns-nihdi-nomenclature"/>
              <code value="102034"/>
            </coding>
          </productOrService>
          <!--  date for item  -->
          <servicedDate value="2017-01-27"/>
          <!--  count for item  -->
          <quantity>
            <value value="1"/>
          </quantity>
          <unitPrice>
            <value value="38.86"/>
            <currency value="EUR"/>
          </unitPrice>
          <net>
            <!--  fee for item  -->
            <value value="38.86"/>
            <currency value="EUR"/>
          </net>
        </item>
        <total>
          <!--  totalFee for the whole attest  -->
          <value value="38.86"/>
          <currency value="EUR"/>
        </total>
      </Claim>
    </resource>
  </entry>
</Bundle>