<?xml version="1.0" encoding="UTF-8"?><Claim xmlns="http://hl7.org/fhir">
  <id value="760152"/>
  <meta>
    <security>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <code value="HTEST"/>
      <display value="test health data"/>
    </security>
  </meta>
  <text>
    <status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Pharmacy Claim</div>
  </text>
  <identifier>
    <system value="http://happypharma.com/claim"/>
    <value value="7612345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="pharmacy"/>
    </coding>
  </type>
  <use value="claim"/>
  <subject>
    <reference value="Patient/1"/>
  </subject>
  <created value="2014-08-16"/>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <provider>
    <reference value="Organization/1"/>
  </provider>
  <priority>
    <coding>
      <code value="stat"/>
    </coding>
  </priority>
  <payee>
    <type>
      <coding>
        <code value="provider"/>
      </coding>
    </type>
  </payee>
  <careTeam>
    <sequence value="1"/>
    <provider>
      <reference value="Practitioner/example"/>
    </provider>
  </careTeam>
  <supportingInfo>
    <sequence value="1"/>
    <category>
      <coding>
        <code value="pharmacyrefill"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://example.org/fhir/CodeSystem/pharmacy-refill"/>
        <code value="new"/>
      </coding>
    </code>
  </supportingInfo>
  <supportingInfo>
    <sequence value="2"/>
    <category>
      <coding>
        <code value="pharmacyinformation"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://example.org/fhir/CodeSystem/pharmacy-information"/>
        <code value="refillsremaining"/>
      </coding>
    </code>
    <valueQuantity>
      <value value="0"/>
    </valueQuantity>
  </supportingInfo>
  <supportingInfo>
    <sequence value="3"/>
    <category>
      <coding>
        <code value="pharmacyinformation"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://example.org/fhir/CodeSystem/pharmacy-information"/>
        <code value="dayssupply"/>
      </coding>
    </code>
    <valueQuantity>
      <value value="10"/>
    </valueQuantity>
  </supportingInfo>
  <supportingInfo>
    <sequence value="4"/>
    <category>
      <coding>
        <code value="pharmacy"/>
      </coding>
    </category>
    <code>
      <coding>
        <system value="http://example.org/fhir/CodeSystem/pharmacy-form"/>
        <code value="capsule"/>
      </coding>
    </code>
  </supportingInfo>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <code value="654456"/>
      </coding>
    </diagnosisCodeableConcept>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamSequence value="1"/>
    <informationSequence value="1"/>
    <informationSequence value="2"/>
    <informationSequence value="3"/>
    <informationSequence value="4"/>
    <!--  type=compoundmedication  -->
    <productOrService>
      <coding>
        <system value="http://localdruglist.org"/>
        <code value="compound"/>
        <display value="Custom compound"/>
      </coding>
    </productOrService>
    <servicedDate value="2014-08-16"/>
    <quantity>
      <value value="30"/>
      <unit value="TAB"/>
      <system value="http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm"/>
      <code value="TAB"/>
    </quantity>
    <net>
      <value value="155.00"/>
      <currency value="USD"/>
    </net>
    <detail>
      <sequence value="1"/>
      <!--  type=packagemedication  -->
      <productOrService>
        <coding>
          <system value="http://localdruglist.org"/>
          <code value="44001"/>
          <display value="Acetaminophen 250mg"/>
        </coding>
      </productOrService>
      <quantity>
        <value value="250"/>
        <unit value="mg"/>
      </quantity>
      <net>
        <value value="20.00"/>
        <currency value="USD"/>
      </net>
      <subDetail>
        <sequence value="1"/>
        <!--  type=costitem  -->
        <productOrService>
          <coding>
            <system value="http://hl7.org/fhir/ex-pharmaservice"/>
            <code value="drugcost"/>
          </coding>
        </productOrService>
        <net>
          <value value="20.00"/>
          <currency value="USD"/>
        </net>
      </subDetail>
    </detail>
    <detail>
      <sequence value="2"/>
      <!--  type=packagemedication  -->
      <productOrService>
        <coding>
          <system value="http://localdruglist.org"/>
          <code value="44035"/>
          <display value="Phenacetin 50mg"/>
        </coding>
      </productOrService>
      <quantity>
        <value value="50"/>
        <unit value="mg"/>
      </quantity>
      <net>
        <value value="25.00"/>
        <currency value="USD"/>
      </net>
      <subDetail>
        <sequence value="1"/>
        <!--  type=costitem  -->
        <productOrService>
          <coding>
            <system value="http://hl7.org/fhir/ex-pharmaservice"/>
            <code value="drugcost"/>
          </coding>
        </productOrService>
        <net>
          <value value="25.00"/>
          <currency value="USD"/>
        </net>
      </subDetail>
    </detail>
    <detail>
      <sequence value="3"/>
      <!--  type=packagemedication  -->
      <productOrService>
        <coding>
          <system value="http://localdruglist.org"/>
          <code value="44057"/>
          <display value="Codeine 25mg"/>
        </coding>
      </productOrService>
      <quantity>
        <value value="25"/>
        <unit value="mg"/>
      </quantity>
      <net>
        <value value="28.00"/>
        <currency value="USD"/>
      </net>
      <subDetail>
        <sequence value="1"/>
        <!--  type=costitem  -->
        <productOrService>
          <coding>
            <system value="http://hl7.org/fhir/ex-pharmaservice"/>
            <code value="drugcost"/>
          </coding>
        </productOrService>
        <net>
          <value value="28.00"/>
          <currency value="USD"/>
        </net>
      </subDetail>
    </detail>
    <detail>
      <sequence value="2"/>
      <!--  type=costitem  -->
      <productOrService>
        <coding>
          <system value="http://hl7.org/fhir/ex-pharmaservice"/>
          <code value="markup"/>
        </coding>
      </productOrService>
      <net>
        <value value="22.00"/>
        <currency value="USD"/>
      </net>
    </detail>
    <detail>
      <sequence value="3"/>
      <!--  type=costitem  -->
      <productOrService>
        <coding>
          <system value="http://hl7.org/fhir/ex-pharmaservice"/>
          <code value="compoundfee"/>
        </coding>
      </productOrService>
      <net>
        <value value="60.00"/>
        <currency value="USD"/>
      </net>
    </detail>
  </item>
  <total>
    <value value="155.00"/>
    <currency value="USD"/>
  </total>
</Claim>