---
type: "example"
title: "CoverageEligibilityRequest Example: coverageeligibilityrequest-example-2"
resource: "CoverageEligibilityRequest"
example: "coverageeligibilityrequest-example-2"
---
# CoverageEligibilityRequest Example: coverageeligibilityrequest-example-2

## Narrative

A human-readable rendering of the CoverageEligibilityRequest

## Example XML



```xml
<CoverageEligibilityRequest xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../schema/remittance.xsd">
	<id value="52346"/>

	<text>
		<status value="generated"/>
		<div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the CoverageEligibilityRequest</div>
	</text>

	<identifier>
		<system value="http://happyvalley.com/coverageelegibilityrequest"/>
		<value value="52346"/>
	</identifier>

	<status value="active"/>

	<priority>
		<coding>
			<code value="normal"/>
		</coding>
	</priority>

	<purpose value="validation"/>
	<purpose value="benefits"/>

	<patient>
		<reference value="Patient/pat1"/>
	</patient>

	<servicedDate value="2014-09-17"/> <!-- Anticipated service date -->

	<created value="2014-08-16"/>

	<enterer>
		<identifier>
			<system value="http://happyvalleyclinic.com/staff"/>
			<value value="14"/>
		</identifier>
	</enterer>

	<provider>
		<reference value="Organization/1"/>
	</provider>

	<insurer>
		<reference value="Organization/2"/>
	</insurer>

	<facility>
		<identifier>
			<system value="http://statecliniclicensor.com/clinicid"/>
			<value value="G35B9"/>
		</identifier>
	</facility>

	<insurance>
		<coverage>
			<reference value="Coverage/9876B1"/>
		</coverage>

		<businessArrangement value="NB8742"/>
	</insurance>

	<item>
		<category>
			<coding>
				<system value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
				<code value="69"/>
				<display value="Maternity"/>
			</coding>
		</category>
	</item>

</CoverageEligibilityRequest>
```