Belgian MyCareNet Profiles
2.0.0 - STU Belgium flag

This page is part of the HL7 Belgium FHIR Implementation Guide - MyCareNet profiles (v2.0.0: Trial Use) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: ex01 - XML Representation

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<Bundle xmlns="http://hl7.org/fhir">
  <id value="ex01"/>
  <meta>
    <profile
             value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementdemand"/>
  </meta>
  <type value="message"/>
  <timestamp value="2015-07-14T11:15:33+02:00"/>
  <entry>
    <fullUrl value="urn:uuid:267b18ce-3d37-4581-9baa-6fada338038b"/>
    <resource>
      <MessageHeader>
        <id value="267b18ce-3d37-4581-9baa-6fada338038b"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-messageheader"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: MessageHeader</b><a name="267b18ce-3d37-4581-9baa-6fada338038b"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource MessageHeader &quot;267b18ce-3d37-4581-9baa-6fada338038b&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-be-messageheader.html">MyCareNet MessageHeader BE profile</a></p></div><p><b>event</b>: claim-ask (Details: https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/message-events code claim-ask = 'claim-ask', stated as 'null')</p><h3>Destinations</h3><table class="grid"><tr><td>-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td>*</td><td>MyCareNet</td><td><code>MyCareNet</code></td></tr></table><p><b>sender</b>: <a href="#Organization_Organization1">See above (Organization/Organization1)</a></p><h3>Sources</h3><table class="grid"><tr><td>-</td><td><b>Endpoint</b></td></tr><tr><td>*</td><td><code>urn:uuid:e2c6f73a-74d8-40f2-af0b-a61ad20c53d4</code></td></tr></table><p><b>focus</b>: <a href="#Claim_Claim1">See above (Claim/Claim1)</a></p></div>
        </text>
        <eventCoding>
          <system
                  value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/message-events"/>
          <code value="claim-ask"/>
        </eventCoding>
        <destination>
          <name value="MyCareNet"/>
          <endpoint value="MyCareNet"/>
        </destination>
        <sender>
          <reference value="Organization/Organization1"/>
        </sender>
        <source>
          <endpoint value="urn:uuid:e2c6f73a-74d8-40f2-af0b-a61ad20c53d4"/>
        </source>
        <focus>
          <reference value="Claim/Claim1"/>
        </focus>
      </MessageHeader>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:e2c6f73a-74d8-40f2-af0b-a61ad20c53d4"/>
    <resource>
      <Organization>
        <id value="Organization1"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-organization"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Organization</b><a name="Organization1"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Organization &quot;Organization1&quot; </p><p style="margin-bottom: 0px">Profile: <a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-organization.html">Organisation core BE profile</a></p></div><p><b>identifier</b>: id: 71000436000</p><p><b>type</b>: hospital <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/CodeSystem-cd-hcparty.html">HCParty</a>#orghospital)</span></p></div>
        </text>
        <identifier>
          <system
                  value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
          <value value="71000436000"/>
        </identifier>
        <type>
          <coding>
            <system
                    value="https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"/>
            <code value="orghospital"/>
          </coding>
        </type>
      </Organization>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:62c7bfad-0cb3-4a39-9abb-3a62e06de834"/>
    <resource>
      <PractitionerRole>
        <id value="PractitionerRole1"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: PractitionerRole</b><a name="PractitionerRole1"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource PractitionerRole &quot;PractitionerRole1&quot; </p><p style="margin-bottom: 0px">Profile: <a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-practitionerrole.html">Practitioner role core BE profile</a></p></div><p><b>practitioner</b>: <a href="#Practitioner_Practitioner1">See above (Practitioner/Practitioner1)</a></p><p><b>code</b>: physiotherapist <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/CodeSystem-cd-hcparty.html">HCParty</a>#persphysiotherapist)</span></p></div>
        </text>
        <practitioner>
          <reference value="Practitioner/Practitioner1"/>
        </practitioner>
        <code>
          <coding>
            <system
                    value="https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"/>
            <code value="persphysiotherapist"/>
          </coding>
        </code>
      </PractitionerRole>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:03972cc4-d781-4285-8d79-0f05810e1931"/>
    <resource>
      <Practitioner>
        <id value="Practitioner1"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitioner"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Practitioner</b><a name="Practitioner1"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Practitioner &quot;Practitioner1&quot; </p><p style="margin-bottom: 0px">Profile: <a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-practitioner.html">Practitioner core BE profile</a></p></div><p><b>identifier</b>: id: 54263481527</p><p><b>name</b>: John Smith </p></div>
        </text>
        <identifier>
          <system
                  value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
          <value value="54263481527"/>
        </identifier>
        <name>
          <family value="Smith"/>
          <given value="John"/>
        </name>
      </Practitioner>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:a52efcb6-1f81-4333-a115-d45bd3183686"/>
    <resource>
      <Patient>
        <id value="Patient1"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Patient</b><a name="Patient1"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Patient &quot;Patient1&quot; </p><p style="margin-bottom: 0px">Profile: <a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-patient.html">Patient core BE profile</a></p></div><p><b>identifier</b>: id: n° inscription mutualiste</p><p><b>name</b>: Jean Dupont </p><p><b>gender</b>: male</p></div>
        </text>
        <identifier>
          <system
                  value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancymembership"/>
          <value value="n° inscription mutualiste"/>
          <assigner>
            <identifier>
              <system
                      value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/insurancenumber"/>
              <value value="n° mutualité"/>
            </identifier>
          </assigner>
        </identifier>
        <name>
          <family value="Dupont"/>
          <given value="Jean"/>
        </name>
        <gender value="male"/>
      </Patient>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:035e3de4-011f-48a4-92c9-15b2bbcec321"/>
    <resource>
      <PractitionerRole>
        <id value="PractitionerRole2"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitionerrole"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: PractitionerRole</b><a name="PractitionerRole2"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource PractitionerRole &quot;PractitionerRole2&quot; </p><p style="margin-bottom: 0px">Profile: <a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-practitionerrole.html">Practitioner role core BE profile</a></p></div><p><b>practitioner</b>: <a href="#Practitioner_Practitioner2">See above (Practitioner/Practitioner2)</a></p><p><b>code</b>: physician <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/CodeSystem-cd-hcparty.html">HCParty</a>#persphysician)</span></p></div>
        </text>
        <practitioner>
          <reference value="Practitioner/Practitioner2"/>
        </practitioner>
        <code>
          <coding>
            <system
                    value="https://www.ehealth.fgov.be/standards/fhir/core/CodeSystem/cd-hcparty"/>
            <code value="persphysician"/>
          </coding>
        </code>
      </PractitionerRole>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:8fc72085-d349-4bd7-ba84-91a935a4e3c6"/>
    <resource>
      <Practitioner>
        <id value="Practitioner2"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-practitioner"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Practitioner</b><a name="Practitioner2"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Practitioner &quot;Practitioner2&quot; </p><p style="margin-bottom: 0px">Profile: <a href="https://www.ehealth.fgov.be/standards/fhir/core/2.0.0/StructureDefinition-be-practitioner.html">Practitioner core BE profile</a></p></div><p><b>identifier</b>: id: 19234011004</p><p><b>name</b>: Prénom du prescripteur Nom du prescripteur </p></div>
        </text>
        <identifier>
          <system
                  value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/nihdi"/>
          <value value="19234011004"/>
        </identifier>
        <name>
          <family value="Nom du prescripteur"/>
          <given value="Prénom du prescripteur"/>
        </name>
      </Practitioner>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:b3586cda-f1e5-4c58-a389-94249957d87a"/>
    <resource>
      <ServiceRequest>
        <id value="ServiceRequest1"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementservicerequest"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: ServiceRequest</b><a name="ServiceRequest1"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource ServiceRequest &quot;ServiceRequest1&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-be-eagreementservicerequest.html">MyCareNet eAgreement ServiceRequest BE profile</a></p></div><p><b>status</b>: active</p><p><b>intent</b>: order</p><p><b>category</b>: Physical therapy procedure <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#91251008)</span></p><p><b>code</b>: Physical therapy procedure <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#91251008)</span></p><p><b>quantity</b>: 15</p><p><b>subject</b>: <a href="#Patient_Patient1">See above (Patient/Patient1)</a></p><p><b>authoredOn</b>: 2015-07-10</p><p><b>requester</b>: <a href="#PractitionerRole_PractitionerRole2">See above (PractitionerRole/PractitionerRole2)</a></p><p><b>supportingInfo</b>: <a name="annexSR1"> </a></p><blockquote><p/><p><a name="annexSR1"> </a></p><p><b>contentType</b>: application/pdf</p><p><b>data</b>: QW5uZXhlIGlubGluZSwgYmFzZTY0ZWQ=</p></blockquote><hr/><blockquote><p><b>Generated Narrative: Binary #annexSR1</b><a name="annexSR1"> </a></p><p><b>contentType</b>: application/pdf</p><p><b>data</b>: QW5uZXhlIGlubGluZSwgYmFzZTY0ZWQ=</p></blockquote></div>
        </text>
        <contained>
          <Binary>
            <id value="annexSR1"/>
            <contentType value="application/pdf"/>
            <data value="QW5uZXhlIGlubGluZSwgYmFzZTY0ZWQ="/>
          </Binary>
        </contained>
        <status value="active"/>
        <intent value="order"/>
        <category>
          <coding>
            <system value="http://snomed.info/sct"/>
            <code value="91251008"/>
            <display value="Physical therapy procedure"/>
          </coding>
        </category>
        <code>
          <coding>
            <system value="http://snomed.info/sct"/>
            <code value="91251008"/>
            <display value="Physical therapy procedure"/>
          </coding>
        </code>
        <quantityQuantity>
          <value value="15"/>
        </quantityQuantity>
        <subject>
          <reference value="Patient/Patient1"/>
        </subject>
        <authoredOn value="2015-07-10"/>
        <requester>
          <reference value="PractitionerRole/PractitionerRole2"/>
        </requester>
        <supportingInfo>
          <reference value="#annexSR1"/>
        </supportingInfo>
      </ServiceRequest>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:3b8e1245-b480-4af6-90c0-f67037ef276b"/>
    <resource>
      <ServiceRequest>
        <id value="ServiceRequest2"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementservicerequest"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: ServiceRequest</b><a name="ServiceRequest2"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource ServiceRequest &quot;ServiceRequest2&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-be-eagreementservicerequest.html">MyCareNet eAgreement ServiceRequest BE profile</a></p></div><p><b>identifier</b>: id: n° de la prescription</p><p><b>status</b>: active</p><p><b>intent</b>: order</p><p><b>subject</b>: <a href="#Patient_Patient1">See above (Patient/Patient1)</a></p><p><b>requester</b>: <a href="#PractitionerRole_PractitionerRole2">See above (PractitionerRole/PractitionerRole2)</a></p></div>
        </text>
        <identifier>
          <system
                  value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/uhmep"/>
          <value value="n° de la prescription"/>
        </identifier>
        <status value="active"/>
        <intent value="order"/>
        <subject>
          <reference value="Patient/Patient1"/>
        </subject>
        <requester>
          <reference value="PractitionerRole/PractitionerRole2"/>
        </requester>
      </ServiceRequest>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:e85173bc-6f0d-480b-a2cd-2b70d9ffff7a"/>
    <resource>
      <Claim>
        <id value="Claim1"/>
        <meta>
          <profile
                   value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/StructureDefinition/be-eagreementclaim-kine"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Claim</b><a name="Claim1"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Claim &quot;Claim1&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-be-eagreementclaim-kine.html">MyCareNet eAgreement Claim Kine BE profile</a></p></div><p><b>status</b>: active</p><p><b>type</b>: Professional <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html">Claim Type Codes</a>#professional)</span></p><p><b>subType</b>: physiotherapy-fb <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-agreement-types.html">CodeSystem agreement types</a>#physiotherapy-fb)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href="#Patient_Patient1">See above (Patient/Patient1)</a></p><p><b>billablePeriod</b>: 2020-01-15 --&gt; (ongoing)</p><p><b>created</b>: 2015-07-14 11:15:30+0200</p><p><b>enterer</b>: <a href="#PractitionerRole_PractitionerRole1">See above (PractitionerRole/PractitionerRole1)</a></p><p><b>provider</b>: <a href="#PractitionerRole_PractitionerRole1">See above (PractitionerRole/PractitionerRole1)</a></p><p><b>priority</b>: Immediate <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-processpriority.html">Process Priority Codes</a>#stat)</span></p><p><b>referral</b>: <a href="#ServiceRequest_ServiceRequest1">See above (ServiceRequest/ServiceRequest1)</a></p><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: Attachment <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-claiminformationcategory.html">Claim Information Category Codes</a>#attachment)</span></p><p><b>code</b>: functional-report <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-annex-types.html">CodeSystem annex types</a>#functional-report)</span></p><p><b>value</b>: </p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: Information <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-claiminformationcategory.html">Claim Information Category Codes</a>#info)</span></p><p><b>value</b>: additional Information</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 3</p><p><b>category</b>: Information <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-claiminformationcategory.html">Claim Information Category Codes</a>#info)</span></p><p><b>value</b>: <a href="#ServiceRequest_ServiceRequest2">See above (ServiceRequest/ServiceRequest2)</a></p></blockquote><h3>Insurances</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>1</td><td>true</td><td><span>: use of mandatory insurance coverage, no further details provided here.</span></td></tr></table><h3>Items</h3><table class="grid"><tr><td>-</td><td><b>Sequence</b></td><td><b>ProductOrService</b></td><td><b>Serviced[x]</b></td></tr><tr><td>*</td><td>1</td><td>fb-51 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-nihdi-physiotherapy-pathologysituationcode.html">CodeSystem NIHDIPhysiotherapyPathology</a>#fb-51)</span></td><td>2020-01-14</td></tr></table></div>
        </text>
        <status value="active"/>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
            <code value="professional"/>
          </coding>
        </type>
        <subType>
          <coding>
            <system
                    value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/agreement-types"/>
            <code value="physiotherapy-fb"/>
          </coding>
        </subType>
        <use value="preauthorization"/>
        <patient>
          <reference value="Patient/Patient1"/>
        </patient>
        <billablePeriod>
          <start value="2020-01-15"/>
        </billablePeriod>
        <created value="2015-07-14T11:15:30+02:00"/>
        <enterer>
          <reference value="PractitionerRole/PractitionerRole1"/>
        </enterer>
        <provider>
          <reference value="PractitionerRole/PractitionerRole1"/>
        </provider>
        <priority>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/processpriority"/>
            <code value="stat"/>
          </coding>
        </priority>
        <referral>
          <reference value="ServiceRequest/ServiceRequest1"/>
        </referral>
        <supportingInfo>
          <sequence value="1"/>
          <category>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
              <code value="attachment"/>
            </coding>
          </category>
          <code>
            <coding>
              <system
                      value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/annex-types"/>
              <code value="functional-report"/>
            </coding>
          </code>
          <valueAttachment>
            <contentType value="application/pdf"/>
            <data value="QW5uZXhlIGlubGluZSwgYmFzZTY0ZWQ="/>
            <title value="nom/description de l'annexe"/>
          </valueAttachment>
        </supportingInfo>
        <supportingInfo>
          <sequence value="2"/>
          <category>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
              <code value="info"/>
            </coding>
          </category>
          <valueString value="additional Information"/>
        </supportingInfo>
        <supportingInfo>
          <sequence value="3"/>
          <category>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
              <code value="info"/>
            </coding>
          </category>
          <valueReference>
            <reference value="ServiceRequest/ServiceRequest2"/>
          </valueReference>
        </supportingInfo>
        <insurance>
          <sequence value="1"/>
          <focal value="true"/>
          <coverage>
            <display
                     value="use of mandatory insurance coverage, no further details provided here."/>
          </coverage>
        </insurance>
        <item>
          <sequence value="1"/>
          <productOrService>
            <coding>
              <system
                      value="https://www.ehealth.fgov.be/standards/fhir/mycarenet/CodeSystem/nihdi-physiotherapy-pathologysituationcode"/>
              <code value="fb-51"/>
            </coding>
          </productOrService>
          <servicedDate value="2020-01-14"/>
        </item>
      </Claim>
    </resource>
  </entry>
</Bundle>