<Claim xmlns="http://hl7.org/fhir"><id value="660151"/><text><status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the Vision Claim for Glasses</div></text><identifier><system value="http://happysight.com/claim"/><value value="6612346"/></identifier><status value="active"/><type><coding><system value="http://terminology.hl7.org/CodeSystem/claim-type"/><code value="vision"/></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="normal"/></coding></priority><prescription><reference value="http://www.optdocs.com/prescription/12345"/></prescription><payee><type><coding><code value="provider"/></coding></type></payee><careTeam><sequence value="1"/><provider><reference value="Practitioner/example"/></provider></careTeam><diagnosis><sequence value="1"/><diagnosisCodeableConcept><coding><code value="654321"/></coding></diagnosisCodeableConcept></diagnosis><insurance><sequence value="1"/><focal value="true"/><coverage><reference value="Coverage/9876B1"/></coverage></insurance><item><sequence value="1"/><careTeamSequence value="1"/><productOrService><coding><system value="http://example.org/fhir/CodeSystem/ex-visionservice"/><code value="glasses"/></coding></productOrService><servicedDate value="2014-08-16"/><unitPrice><value value="214.00"/><currency value="USD"/></unitPrice><net><value value="214.00"/><currency value="USD"/></net><detail><sequence value="1"/><productOrService><coding><system value="http://example.org/fhir/CodeSystem/ex-visionservice"/><code value="frame"/></coding></productOrService><unitPrice><value value="100.00"/><currency value="USD"/></unitPrice><net><value value="100.00"/><currency value="USD"/></net></detail><detail><sequence value="2"/><productOrService><coding><system value="http://example.org/fhir/CodeSystem/ex-visionservice"/><code value="lens"/></coding></productOrService><quantity><value value="2"/></quantity><unitPrice><value value="50.00"/><currency value="USD"/></unitPrice><net><value value="100.00"/><currency value="USD"/></net></detail><detail><sequence value="3"/><productOrService><coding><system value="http://example.org/fhir/CodeSystem/ex-visionservice"/><code value="fst"/></coding></productOrService><unitPrice><value value="200.00"/><currency value="USD"/></unitPrice><factor value="0.07"/><net><value value="14.00"/><currency value="USD"/></net></detail></item></Claim>