<?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"/>

	<patient>
		<reference value="Patient/1"/>
	</patient>

	<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>