{
  "resourceType": "Claim",
  "id": "a5fb2468-d91a-41a3-8ea1-0eafd99e97b6",
  "identifier": [
    {
      "system": "urn:uuid:mitre-drls",
      "value": "4u5_167Yi"
    }
  ],
  "status": "active",
  "type": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/claim-type",
        "code": "professional",
        "display": "Professional"
      }
    ]
  },
  "use": "preauthorization",
  "patient": {
    "reference": "Patient/pat013"
  },
  "created": "2026-10-16T21:30:08.391Z",
  "insurer": {
    "reference": "Organization/org1234"
  },
  "provider": {
    "reference": "Practitioner/pra1234"
  },
  "priority": {
    "coding": [
      {
        "code": "normal"
      }
    ]
  },
  "facility": {
    "reference": "Location/loc1234"
  },
  "careTeam": [
    {
      "extension": [
        {
          "url": "http://terminology.hl7.org/ValueSet/v2-0912",
          "valueCode": "OP"
        }
      ],
      "sequence": 1,
      "provider": {
        "reference": "Practitioner/pra1234"
      }
    }
  ],
  "supportingInfo": [
    {
      "sequence": 1,
      "category": {
        "coding": [
          {
            "system": "http://hl7.org/us/davinci-pas/CodeSystem/PASSupportingInfoType",
            "code": "patientEvent"
          }
        ]
      },
      "timingPeriod": {
        "start": "2020-01-01",
        "end": "2021-01-01"
      }
    },
    {
      "sequence": 2,
      "category": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
            "code": "info",
            "display": "Information"
          }
        ]
      },
      "valueReference": {
        "reference": "QuestionnaireResponse/undefined"
      }
    }
  ],
  "insurance": [
    {
      "sequence": 1,
      "focal": true
    }
  ],
  "item": [
    {
      "sequence": 1,
      "careTeamSequence": [
        1
      ],
      "productOrService": {
        "coding": [
          {
            "system": "https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
            "code": "E0607",
            "display": "Home blood glucose monitor"
          }
        ]
      },
      "quantity": {
        "value": 1
      }
    }
  ]
}