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

<Claim xmlns="http://hl7.org/fhir">
  <id value="ExampleZeEigenanteilAndersartigClaim"/>
  <text>
    <status value="extensions"/><div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Claim ExampleZeEigenanteilAndersartigClaim</b></p><a name="ExampleZeEigenanteilAndersartigClaim"> </a><a name="hcExampleZeEigenanteilAndersartigClaim"> </a><p><b>ZE Bonus-Prozent</b>: 70</p><p><b>Eigenanteil Regelversorgung</b>: <span title="Euro">€180,00</span> (EUR)</p><p><b>Eigenanteil andersartige Versorgung</b>: <span title="Euro">€580,00</span> (EUR)</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type oral}">Oral</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href="Patient-pat-gkv-dental-01.html">Aylin Özdemir (official) (no stated gender), DoB: 1988-03-14 ( Krankenversichertennummer)</a></p><p><b>created</b>: 2026-02-10</p><p><b>provider</b>: <a href="PractitionerRole-role-schoell-gibitzenhof.html">PractitionerRole Doctor</a></p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></p><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>true</td><td><a href="Coverage-cov-gkv-dental-01-gkv.html">Coverage: status = active; type = Gesetzliche Krankenversicherung; period = 2024-01-01 --&gt; (ongoing)</a></td></tr></table></div>
  </text>
  <extension url="https://fhir.cognovis.de/dental/StructureDefinition/ze-bonus-prozent">
    <valueInteger value="70"/>
  </extension>
  <extension url="https://fhir.cognovis.de/dental/StructureDefinition/eigenanteil-regelversorgung">
    <valueMoney>
      <value value="180"/>
      <currency value="EUR"/>
    </valueMoney>
  </extension>
  <extension url="https://fhir.cognovis.de/dental/StructureDefinition/eigenanteil-andersartig">
    <valueMoney>
      <value value="580"/>
      <currency value="EUR"/>
    </valueMoney>
  </extension>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="oral"/>
      <display value="Oral"/>
    </coding>
  </type>
  <use value="claim"/>
  <patient>
    <reference value="Patient/pat-gkv-dental-01"/>
  </patient>
  <created value="2026-02-10"/>
  <provider>
    <reference value="PractitionerRole/role-schoell-gibitzenhof"/>
  </provider>
  <priority>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
      <code value="normal"/>
    </coding>
  </priority>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/cov-gkv-dental-01-gkv"/>
    </coverage>
  </insurance>
</Claim>