{
  "resourceType" : "Claim",
  "type" : "<code>", 
  "identifier" : [" Identifier "], 
  "ruleset" : " Coding ",
  "originalRuleset" : " Coding ",
  "created" : "<dateTime>", 
  "target" : " Reference(Organization) ", 
  "provider" : " Reference(Practitioner) ", 
  "organization" : " Reference(Organization) ", 
  "use" : "<code>", 
  "priority" : " Coding ", 
  "fundsReserve" : " Coding ", 
  "enterer" : " Reference(Practitioner) ", 
  "facility" : " Reference(Location) ", 
  "prescription" : " Reference(MedicationOrder|VisionPrescription) ", 
  "originalPrescription" : " Reference(MedicationOrder) ", 
  "payee" : { 
    "type" : " Coding ", 
    "provider" : " Reference(Practitioner) ", 
    "organization" : " Reference(Organization) ", 
    "person" : " Reference(Patient) " 
  },
  "referral" : " Reference(ReferralRequest) ", 
  "diagnosis" : [{ 
    "sequence" : "<positiveInt>", 
    "diagnosis" : " Coding " 
  }],
  "condition" : [" Coding "], 
  "patient" : " Reference(Patient) ", 
  "coverage" : [{ 
    "sequence" : "<positiveInt>", 
    "focal" : "<boolean>", 
    "coverage" : " Reference(Coverage) ",
    "businessArrangement" : "<string>",
    "relationship" : " Coding ", 
    "preAuthRef" : ["<string>"], 
    "claimResponse" : " Reference(ClaimResponse) ", 
    "originalRuleset" : " Coding " 
  }],
  "exception" : [" Coding "], 
  "school" : "<string>", 
  "accident" : "<date>", 
  "accidentType" : " Coding ", 
  "interventionException" : [" Coding "], 
  "item" : [{ 
    "sequence" : "<positiveInt>", 
    "type" : " Coding ", 
    "provider" : " Reference(Practitioner) ", 
    "diagnosisLinkId" : ["<positiveInt>"], 
    "service" : " Coding ",
    "serviceDate" : "<date>", 
    "quantity" : " Quantity(SimpleQuantity) ", 
    "unitPrice" : " Quantity(Money) ", 
    "factor" : "<decimal>", 
    "points" : "<decimal>", 
    "net" : " Quantity(Money) ", 
    "udi" : " Coding ", 
    "bodySite" : " Coding ", 
    "subSite" : [" Coding "], 
    "modifier" : [" Coding "], 
    "detail" : [{ 
      "sequence" : "<positiveInt>", 
      "type" : " Coding ", 
      "service" : " Coding ", 
      "quantity" : " Quantity(SimpleQuantity) ", 
      "unitPrice" : " Quantity(Money) ", 
      "factor" : "<decimal>", 
      "points" : "<decimal>", 
      "net" : " Quantity(Money) ", 
      "udi" : " Coding ", 
      "subDetail" : [{ 
        "sequence" : "<positiveInt>", 
        "type" : " Coding ", 
        "service" : " Coding ", 
        "quantity" : " Quantity(SimpleQuantity) ", 
        "unitPrice" : " Quantity(Money) ", 
        "factor" : "<decimal>", 
        "points" : "<decimal>", 
        "net" : " Quantity(Money) ", 
        "udi" : " Coding " 
      }]
    }],
    "prosthesis" : { 
      "initial" : "<boolean>", 
      "priorDate" : "<date>", 
      "priorMaterial" : " Coding " 
    }
  }],
  "additionalMaterials" : [" Coding "], 
  "missingTeeth" : [{ 
    "tooth" : " Coding ", 
    "reason" : " Coding ", 
    "extractionDate" : "<date>" 
  }]
}