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

<Claim xmlns="http://hl7.org/fhir">
  <text>
    <status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Claim PharmacySubmittedClaim</b></p><a name="PharmacySubmittedClaim"> </a><a name="hcPharmacySubmittedClaim"> </a><p><b>identifier</b>: <code>https://api.messaging.digital.health.nz/fileID</code>/7612345 (use: secondary, )</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type pharmacy}">Pharmacy</span></p><p><b>subType</b>: <span title="Codes:{https://example.com/HeaderType ExampleRecordType}">ExampleRecordType</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: Carey Carrington (Identifier: <a href="http://fhir.org.nz/ig/base/NamingSystem-nhi.html" title="NHI number">NHI</a>/ZXP7823 (use: official, ))</p><p><b>created</b>: 2014-08-16</p><p><b>insurer</b>: <a href="Organization/43242343232">Organization/43242343232</a></p><p><b>provider</b>: <a href="Organization/54739649856">Organization/54739649856</a></p><p><b>priority</b>: <span title="Codes:">stat</span></p><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><a href="Coverage/9876B1">Coverage/9876B1</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title="Codes:{https://example.com/productOrService 562721}">Alprazolam 0.25mg (Xanax)</span></p><p><b>serviced</b>: 2014-08-16</p><p><b>quantity</b>: 90 TAB<span style="background: LightGoldenRodYellow"> (Details: UCUM  codeTAB = 'TAB')</span></p><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>90</td><td>New Zealand dollar</td></tr></table><blockquote><p><b>detail</b></p><p><b>sequence</b>: 1</p><p><b>productOrService</b>: <span title="Codes:{https://example.com/productOrService drugcost}">drugcost</span></p><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>45</td><td>New Zealand dollar</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>sequence</b>: 2</p><p><b>productOrService</b>: <span title="Codes:{https://example.com/productOrServicee suspension}">suspension</span></p><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>9</td><td>New Zealand dollar</td></tr></table></blockquote><blockquote><p><b>detail</b></p><p><b>sequence</b>: 3</p><p><b>productOrService</b>: <span title="Codes:{https://example.com/productOrService dispensefee}">dispensefee</span></p><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>36</td><td>New Zealand dollar</td></tr></table></blockquote></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>90</td><td>New Zealand dollar</td></tr></table></div>
  </text>
  <identifier>
    <use value="secondary"/>
    <system value="https://api.messaging.digital.health.nz/fileID"/>
    <value value="7612345"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="pharmacy"/>
    </coding>
  </type>
  <subType>
    <coding>
      <system value="https://example.com/HeaderType"/>
      <code value="ExampleRecordType"/>
    </coding>
  </subType>
  <use value="claim"/>
  <patient>
    <identifier>
      <use value="official"/>
      <system value="https://standards.digital.health.nz/ns/nhi-id"/>
      <value value="ZXP7823"/>
    </identifier>
    <display value="Carey Carrington"/>
  </patient>
  <created value="2014-08-16"/>
  <insurer>
    <reference value="Organization/43242343232"/>
  </insurer>
  <provider>
    <reference value="Organization/54739649856"/>
  </provider>
  <priority>
    <coding>
      <code value="stat"/>
    </coding>
  </priority>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <productOrService>
      <coding>
        <system value="https://example.com/productOrService"/>
        <code value="562721"/>
        <display value="Alprazolam 0.25mg (Xanax)"/>
      </coding>
    </productOrService>
    <servicedDate value="2014-08-16"/>
    <quantity>
      <value value="90"/>
      <unit value="TAB"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="TAB"/>
    </quantity>
    <net>
      <value value="90"/>
      <currency value="NZD"/>
    </net>
    <detail>
      <sequence value="1"/>
      <productOrService>
        <coding>
          <system value="https://example.com/productOrService"/>
          <code value="drugcost"/>
        </coding>
      </productOrService>
      <net>
        <value value="45"/>
        <currency value="NZD"/>
      </net>
    </detail>
    <detail>
      <sequence value="2"/>
      <productOrService>
        <coding>
          <system value="https://example.com/productOrServicee"/>
          <code value="suspension"/>
        </coding>
      </productOrService>
      <net>
        <value value="9"/>
        <currency value="NZD"/>
      </net>
    </detail>
    <detail>
      <sequence value="3"/>
      <productOrService>
        <coding>
          <system value="https://example.com/productOrService"/>
          <code value="dispensefee"/>
        </coding>
      </productOrService>
      <net>
        <value value="36"/>
        <currency value="NZD"/>
      </net>
    </detail>
  </item>
  <total>
    <value value="90"/>
    <currency value="NZD"/>
  </total>
</Claim>