---
type: "example"
title: "PaymentNotice Example: paymentnotice-example"
resource: "PaymentNotice"
example: "paymentnotice-example"
---
# PaymentNotice Example: paymentnotice-example

## Narrative

A human-readable rendering of the PaymentNotice

## Example XML



```xml
<PaymentNotice 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="77654"/>

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

	<identifier>
		<system value="http://benefitsinc.com/paymentnotice"/>
		<value value="776543"/>
	</identifier>

	<status value="active"/>

	<request>
		<reference value="http://benefitsinc.com/fhir/claim/12345"/>
	</request>

	<response>
		<reference value="http://benefitsinc.com/fhir/claimresponse/CR12345"/>
	</response>

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

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

	<payment>
		<reference value="PaymentReconciliation/ER2500"/>
	</payment>

	<paymentDate value="2014-08-15"/>

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

	<recipient>
		<identifier>
			<system value="http://regulators.gov"/>
			<value value="AB123"/>
		</identifier>
	</recipient>

	<amount>
		<value value="12500.00"/>
		<currency value="USD"/> 
	</amount>

	<paymentStatus>
		<coding>
			<system value="http://terminology.hl7.org/CodeSystem/paymentstatus"/>
			<code value="paid"/>
		</coding>
	</paymentStatus>

</PaymentNotice>
```