{
  "resourceType": "ExplanationOfBenefit",
  "id": "explanationofbenefit-mbs-example-01",
  "meta": {
    "profile": [
      "http://ns.electronichealth.net.au/ci/fhir/StructureDefinition/explanationofbenefit-medicare"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: explanationofbenefit-mbs-example-01</p><p><b>meta</b>: </p><p><b>contained</b>: , , </p><p><b>identifier</b>: urn:oid:2.25.129844986816735724544008039950138526110</p><p><b>type</b>: Professional <span style=\"background: LightGoldenRodYellow\">(Details : {http://hl7.org/fhir/ex-claimtype code 'professional' = 'Professional)</span></p><p><b>subType</b>: mbs <span style=\"background: LightGoldenRodYellow\">(Details : {https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1 code 'mbs' = 'mbs)</span></p><p><b>patient</b>: </p><p><b>created</b>: 21/06/2016</p><p><b>provider</b>: unknown resource contained</p><p><b>referral</b>: unknown resource contained</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Service</b></td><td><b>Serviced[x]</b></td><td><b>Location[x]</b></td></tr><tr><td>*</td><td>1</td><td>MBS <span style=\"background: LightGoldenRodYellow\">(Details : {https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1 code 'mbs' = 'mbs', given as 'MBS'})</span></td><td>Radiation oncology treatment <span style=\"background: LightGoldenRodYellow\">(Details : {urn:oid:1.2.36.1.2001.1005.21 code '15275' = '15275', given as 'Radiation oncology treatment'})</span></td><td>16/06/2016</td><td>Inpatient Hospital <span style=\"background: LightGoldenRodYellow\">(Details : {http://hl7.org/fhir/ex-serviceplace code '21' = 'Inpatient Hospital', given as 'Inpatient Hospital'})</span></td></tr></table></div>"
  },
  "contained": [
    {
      "resourceType": "ReferralRequest",
      "id": "ReferralRequest1",
      "meta": {
        "profile": [
          "http://ns.electronichealth.net.au/ci/fhir/StructureDefinition/referralrequest-mbsdva"
        ]
      },
      "status": "completed",
      "intent": "order",
      "subject": {
        "identifier": {
          "type": {
            "coding": [
              {
                "system": "http://hl7.org/fhir/v2/0203",
                "code": "NI",
                "display": "National unique individual identifier"
              }
            ]
          },
          "system": "http://ns.electronichealth.net.au/id/hi/ihi/1.0",
          "value": "8003608166690503"
        }
      },
      "requester": {
        "agent": {
          "reference": "#Practitioner2"
        }
      }
    },
    {
      "resourceType": "Practitioner",
      "id": "Practitioner1",
      "meta": {
        "profile": [
          "http://hl7.org.au/fhir/StructureDefinition/au-practitioner"
        ]
      },
      "identifier": [
        {
          "type": {
            "coding": [
              {
                "system": "http://hl7.org/fhir/v2/0203",
                "code": "NPI",
                "display": "National provider identifier"
              }
            ],
            "text": "HPI-I"
          },
          "system": "http://ns.electronichealth.net.au/id/hi/hpii/1.0",
          "value": "8003610833334085"
        }
      ]
    },
    {
      "resourceType": "Practitioner",
      "id": "Practitioner2",
      "meta": {
        "profile": [
          "http://hl7.org.au/fhir/StructureDefinition/au-practitioner"
        ]
      },
      "identifier": [
        {
          "type": {
            "coding": [
              {
                "system": "http://hl7.org.au/fhir/v2/0203",
                "code": "PRES",
                "display": "Prescriber Number"
              }
            ],
            "text": "Prescriber Number"
          },
          "system": "http://ns.electronichealth.net.au/id/prescriber-number",
          "value": "453221"
        }
      ],
      "name": [
        {
          "family": "Good",
          "given": [
            "Fab"
          ],
          "prefix": [
            "Dr"
          ]
        }
      ]
    }
  ],
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.25.129844986816735724544008039950138526110"
    }
  ],
  "type": {
    "coding": [
      {
        "system": "http://hl7.org/fhir/ex-claimtype",
        "code": "professional"
      }
    ]
  },
  "subType": [
    {
      "coding": [
        {
          "system": "https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1",
          "code": "mbs"
        }
      ]
    }
  ],
  "patient": {
    "identifier": {
      "type": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/v2/0203",
            "code": "NI",
            "display": "National unique individual identifier"
          }
        ]
      },
      "system": "http://ns.electronichealth.net.au/id/hi/ihi/1.0",
      "value": "8003608166690503"
    }
  },
  "created": "2016-06-21",
  "provider": {
    "reference": "#Practitioner1"
  },
  "referral": {
    "reference": "#ReferralRequest1"
  },
  "item": [
    {
      "sequence": 1,
      "category": {
        "coding": [
          {
            "system": "https://healthterminologies.gov.au/fhir/CodeSystem/australian-benefit-payment-category-1",
            "code": "mbs",
            "display": "MBS"
          }
        ]
      },
      "service": {
        "coding": [
          {
            "system": "urn:oid:1.2.36.1.2001.1005.21",
            "code": "15275",
            "display": "Radiation oncology treatment"
          }
        ]
      },
      "servicedDate": "2016-06-16",
      "locationCodeableConcept": {
        "coding": [
          {
            "system": "http://hl7.org/fhir/ex-serviceplace",
            "code": "21",
            "display": "Inpatient Hospital"
          }
        ]
      }
    }
  ]
}