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{
    "resourceType": "ClaimResponse",
    "communicationRequest": [
        {
            "reference": "CommunicationRequest/858A706A6991F219-A6BFA4F0-48DC4DD7-998DA5E6-30EFDAF8EDD24A63C48C1E61"
        }
    ],
    "created": "2020-07-1011",
    "id": "858A706A6991F219-A6BFA4F0-48DC4DD7-998DA5E6-30EFDAF8EDD24A63C48C1E61",
    "identifier": [
        {
            "type": {
                "coding": [
                    {
                        "code": "UUID",
                        "system": "https://hl7.org/fhir/valueset-identifier-type.html"
                    }
                ]
            },
            "use": "usual",
            "value": "858A706A6991F219-A6BFA4F0-48DC4DD7-998DA5E6-30EFDAF8EDD24A63C48C1E61"
        },
        {
            "type": {
                "coding": [
                    {
                        "code": "MR",
                        "system": "https://hl7.org/fhir/valueset-identifier-type.html"
                    }
                ]
            },
            "use": "usual",
            "value": "CID00001test1231"
        }
    ],
    "insurer": {
        "reference": "HealthcareService/D61C869BFABA2038-F1840E24-4CAE4557-B61BB1BD-0AD52DDE235408584C48FA0D"
    },
    "item": [
        {
            "adjudication": [
                {
                    "amount": {
                        "currency": "$",
                        "value": 10.0
                    },
                    "category": {
                        "coding": [
                            {
                                "code": "016"
                            }
                        ],
                        "text": "generalvaluated"
                    },
                    "reason": {
                        "coding": [
                            {
                                "code": "10"
                            }
                        ]
                    },
                },
     "value": 2.0           {
       }             ],
"amount": {
           "extension": [            "currency": "$",
   {                     "urlvalue": "Medication",10.0
                    "valueReference": {},
                         "referencecategory": "Medication/0136bb78-35ea-402d-9698-7d57d0dd4c5e"{
                    }    "coding": [
           }             ],    {
           "itemSequence": 1              },       "code": "16"
{             "adjudication": [              }
  {                     "amount": { ],
                        "valuetext": 400.0"valuated"
                    },
                    "categoryreason": {
                        "coding": [
                            {
                                "code": "0"
                            }
                        ],
                    }
         "text": "general"       },
                },{
                    "reasonamount": {
                        "codingcurrency": ["$"
                    },
       {              "category": {
                  "code      "coding": "1"[
                            {
 }                         ]      "code": "16"
             },               }
     "value": 1.0                 } ],
           ],             "extensiontext": ["valuated"
                    {},
                    "urlreason": "ActivityDefinition", {
                        "valueReferencecoding": [
  {                         "reference": "ActivityDefinition/64d165ad-55a2-4b06-ba97-529557a311a4" {
                       }         "code": "0"
      }             ],         }
   "itemSequence": 2         },         {  ]
          "adjudication": [         }
       {         },
           "amount": {    {
                    "valueamount": 1250.0{
                    },    "currency": "$",
               "category": {        "value": 100.0
               "coding": [    },
                    "category": {
                        "coding": [
                            {
                                "code": "016"
                            }
                        ],
                        "text": "generalvaluated"
                    },
                    "reason": {
                        "coding": [
                            {
                                "code": "10"
                            }
                        ]
                    },
                }
   "value": 1.0         ],
       }             ],
            "extension"extension": [
                {
                    "url": "ActivityDefinitionMedication",
                    "valueReference": {
                        "reference": "ActivityDefinitionMedication/a3f8968125bace1d-131c89a9-4fe14e06-8e41a87f-887096b6b04c40bb45fb3485"
                    }
                }
            ],
            "itemSequence": 31,
        }     ],"noteNumber": [
    "outcome": "entered",     "patient": {     1
   "reference": "Patient/1D464C09-5334-407F-9882-14C097B89BBD"     },
    "request": {   ]
        },
        {
            "adjudication": [
                {
                    "amount": {
                        "currency": "$",
                        "value": 400.0
                    },
                    "category": {
                        "coding": [
                            {
                                "code": "16"
                            }
                        ],
                        "text": "valuated"
                    },
                    "reason": {
                        "coding": [
                            {
                                "code": "0"
                            }
                        ]
                    }
                },
                {
                    "amount": {
                        "currency": "$",
                        "value": 400.0
                    },
                    "category": {
                        "coding": [
                            {
                                "code": "16"
                            }
                        ],
                        "text": "valuated"
                    },
                    "reason": {
                        "coding": [
                            {
                                "code": "0"
                            }
                        ]
                    }
                },
                {
                    "amount": {
                        "currency": "$"
                    },
                    "category": {
                        "coding": [
                            {
                                "code": "16"
                            }
                        ],
                        "text": "valuated"
                    },
                    "reason": {
                        "coding": [
                            {
                                "code": "0"
                            }
                        ]
                    }
                },
                {
                    "amount": {
                        "currency": "$",
                        "value": 400.0
                    },
                    "category": {
                        "coding": [
                            {
                                "code": "16"
                            }
                        ],
                        "text": "valuated"
                    },
                    "reason": {
                        "coding": [
                            {
                                "code": "0"
                            }
                        ]
                    }
                }
            ],
            "extension": [
                {
                    "url": "ActivityDefinition",
                    "valueReference": {
                        "reference": "ActivityDefinition/7dfb7acb-6c62-4065-9aa6-8e708665bb3c"
                    }
                }
            ],
            "itemSequence": 2,
            "noteNumber": [
                2
            ]
        }
    ],
    "outcome": "valuated",
    "patient": {
        "reference": "Patient/8CD74B9F-7641-421B-A108-C5DB610BE9FD"
    },
    "processNote": [
        {
            "number": 1,
            "text": "P"
        },
        {
            "number": 2,
            "text": "P"
        }
    ],
    "request": {
        "reference": "Claim/6991F219-A4F0-4DD7-A5E6-4A63C48C1E61"
    },
    "status": "completed",
    "total": [
        {
            "amount": {
                "currency": "$",
                "value": 500.0
            },
            "category": {
                "coding": [
                    {
                        "code": "A",
                        "display": "Approved",
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication.html"
                    }
          "reference": "Claim/858A706A-A6BF-48DC-998D-30EFDAF8EDD2"     }],
    "status            "text": "draft",Valuated < Reinsured < Approved < Claimed"
            }
       "total": [ },
        {
            "amount": {
                "currency": "$",
                "value": 1670500.0
            },
            "category": {
                "coding": [
                    {
                        "code": "C",
                        "display": "Claimed",
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication.html"
                    }
                ],
                "text": "Valuated < Reinsured < Approved < Claimed"
            }
        }
    ],
    "type": {
        "text": "O"
    },
    "use": "claim"
}