{
  "resourceType": "PaymentNotice",
  "id": "77654",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the PaymentNotice</div>"
  },
  "identifier": [
    {
      "system": "http://benefitsinc.com/paymentnotice",
      "value": "776543"
    }
  ],
  "status": "active",
  "created": "2014-08-16",
  "organizationReference": {
    "reference": "Organization/1"
  },
  "requestReference": {
    "reference": "http://benefitsinc.com/fhir/oralhealthclaim/12345"
  },
  "paymentStatus": {
    "system": "http://hl7.org/fhir/paymentstatus",
    "code": "paid"
  }
}