<Parameters xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../input-cache/schemas/R5/fhir-single.xsd">
  <!-- Typically this resource would not have an id.  One is provided because it's needed for IG publication purposes -->
  <id value="example-Parameters-reverse-receipts" />
  <parameter>
    <name value="receipt" />
    <part>
      <name value="patient" />
      <valueReference>
        <reference value="Patient/example-Patient" />
        <!-- This would normally be the odb number for the patient -->
      </valueReference>
    </part>
    <part>
      <name value="product" />
      <valueCoding>
        <system value="http://hl7.org/fhir/NamingSystem/ca-hc-din" />
        <code value="9853359" />
      </valueCoding>
    </part>
    <part>
      <name value="date" />
      <valueDate value="2023-08-13" />
    </part>
    <part>
      <name value="duplicateVersion" />
      <valueUnsignedInt value="1" />
    </part>
    <part>
      <name value="reason" />
      <valueCoding>
        <system value="https://bpcs.exchange/fhir/CodeSystem/cs-ReceiptReverseReason" />
        <code value="DE" />
      </valueCoding>
    </part>
    <part>
      <name value="coverage" />
      <valueReference>
        <reference value="http://example.org/Coverage/12345" />
      </valueReference>
    </part>
    <part>
      <name value="paid" />
      <valueBoolean value="true" />
    </part>
  </parameter>
</Parameters>