<?xml version="1.0" encoding="UTF-8"?>

<ChargeItem xmlns="http://hl7.org/fhir">
  <id value="a1b2c3d4-1e24-41c8-b71b-0e701af7583d"/>
  <meta>
    <profile value="https://fhir.xealth.io/StructureDefinition/xealth-chargeitem"/>
  </meta>
  <text>
    <status value="extensions"/><div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ChargeItem a1b2c3d4-1e24-41c8-b71b-0e701af7583d</b></p><a name="a1b2c3d4-1e24-41c8-b71b-0e701af7583d"> </a><a name="hca1b2c3d4-1e24-41c8-b71b-0e701af7583d"> </a><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"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-xealth-chargeitem.html">Xealth ChargeItem</a></p></div><p><b>Ehr Order Id</b>: 12345</p><p><b>identifier</b>: <code>https://fhir.xealth.io/CodeSystem/xealth-deployment/example-deployment/fhir-r4-id</code>/12345</p><p><b>status</b>: Billable</p><p><b>code</b>: <span title="Codes:{http://www.ama-assn.org/go/cpt 99454}">REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D</span></p><p><b>subject</b>: <a href="Patient-ExampleXealthPatient.html">Xealth Profile Test  Male, DoB: 1986-07-13 ( XPID: xealth-17328-1732489-17846492-3128691 (use: official, ))</a></p><p><b>occurrence</b>: 2026-03-31</p><h3>Performers</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Function</b></td><td><b>Actor</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/v2-0912 OP}">Ordering Provider</span></td><td>Dr. Xealth Test (Identifier: <a href="http://terminology.hl7.org/7.2.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/1234567890)</td></tr></table><p><b>performingOrganization</b>: <a href="Organization-ExampleOrganization.html">Organization Health Level Seven International</a></p><p><b>quantity</b>: 1</p><p><b>supportingInformation</b>: <a href="ServiceRequest-ExampleServiceRequest.html">ServiceRequest: status = active; intent = plan</a></p></div>
  </text>
  <extension url="https://fhir.xealth.io/StructureDefinition/extension-ehr-order-id">
    <valueString value="12345"/>
  </extension>
  <identifier>
    <system value="https://fhir.xealth.io/CodeSystem/xealth-deployment/example-deployment/fhir-r4-id"/>
    <value value="12345"/>
  </identifier>
  <status value="billable"/>
  <code>
    <coding>
      <system value="http://www.ama-assn.org/go/cpt"/>
      <code value="99454"/>
      <display value="REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D"/>
    </coding>
  </code>
  <subject>
    <reference value="Patient/ExampleXealthPatient"/>
  </subject>
  <occurrenceDateTime value="2026-03-31"/>
  <performer>
    <function>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0912"/>
        <code value="OP"/>
      </coding>
      <text value="Ordering Provider"/>
    </function>
    <actor>
      <type value="Practitioner"/>
      <identifier>
        <system value="http://hl7.org/fhir/sid/us-npi"/>
        <value value="1234567890"/>
      </identifier>
      <display value="Dr. Xealth Test"/>
    </actor>
  </performer>
  <performingOrganization>
    <reference value="Organization/ExampleOrganization"/>
  </performingOrganization>
  <quantity>
    <value value="1"/>
  </quantity>
  <supportingInformation>
    <reference value="ServiceRequest/ExampleServiceRequest"/>
  </supportingInformation>
</ChargeItem>