-- XML schema extracted from ITU-T H.860 (04/2014)

<!-- Mammogram in Claim -->
<Claim>
	<ProviderID>xyz789</ProviderID>
	<HealthID>23456789</HealthID>
	<PayerID>insurer</PayerID>
	<ProviderID>hospital1234</ProviderID>
	<GovtID>111-1111-1111111-1</GovtID>
	<Gross>800</Gross>
	<PatientShare>174</PatientShare>
	<Net>626</Net>
			<!-- Encounter information -->
				<Encounter>
				<FacilityID>MF2057</FacilityID>
				<Type>1</Type>
				<PatientID>1245</PatientID>
				<Start>01/01/2009 12:00</Start>
				<End>01/01/2010 15:00</End
			<StartType>3</StartType>
			<EndType>2</EndType>
			</Encounter>
			<Diagnosis>
				<Type>Principal</Type>
				<Code>012.13</Code>
			</Diagnosis>
				<Activity>
					<Start>01/01/2009 13:00</Start>
					<Type>3</Type>
					<Code>77057</Code>
					<Quantity>1</Quantity>
					<Net>313</Net>
					<ClinicianID>clinician3456</ClinicianID>
						<!-- Observation information: observation - Date of Initial Encounter -->
						<Observation>
							<Type>CPT</Type>
							<Code>77057</Code>
							<Value>3342F</Value>
							<ValueType>CPT</ValueType>
						</Observation>
				</Activity>
				<Activity>
					<Start>01/01/2009 13:00</Start>
					<Type>3</Type>
					<Code>77052</Code>
					<Quantity>1</Quantity>
					<Net>313</Net>
					<ClinicianID>clinician3456</ClinicianID>
				</Activity>
</Claim>