<?xml version="1.0"?>
<Claim.Submission xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema">
  <Header>
    <SenderID>DHA-F-0045607</SenderID>
    <ReceiverID>TPA026</ReceiverID>
    <TransactionDate>10/12/2023 14:54</TransactionDate>
    <RecordCount>2</RecordCount>
    <DispositionFlag>PRODUCTION</DispositionFlag>
  </Header>
  <Claim>
    <ID>TPA026_INS011_10_12_2023_20190_AP0084715</ID>
    <MemberID>I011-026-115030362-01</MemberID>
    <PayerID>INS011</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>784-1990-6598515-4</EmiratesIDNumber>
    <Gross>35.00</Gross>
    <PatientShare>7.0</PatientShare>
    <Net>28.00</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>AP0084715</PatientID>
      <Start>12/10/2023 00:00</Start>
      <End>12/10/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>K29.00</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>R51.9</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>R14.0</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>12/10/2023 00:00</Start>
      <Type>8</Type>
      <Code>9</Code>
      <Quantity>1.000</Quantity>
      <Net>28.00</Net>
      <Clinician>DHA-P-0242755</Clinician>
      <Observation>
        <Type>Result</Type>
        <Code>BPS</Code>
        <Value>119</Value>
        <ValueType>12/10/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BPD</Code>
        <Value>77</Value>
        <ValueType>12/10/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BMI</Code>
        <Value>27.14</Value>
        <ValueType>12/10/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>Weight</Code>
        <Value>86.00</Value>
        <ValueType>12/10/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>has fullness of abdomen since 1 week has epigastric discomfort</Value>
        <ValueType>Presenting Complaints</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>has hedache 3 days</Value>
        <ValueType>Other</ValueType>
      </Observation>
    </Activity>
  </Claim>
  <Claim>
    <ID>TPA026_INS011_10_12_2023_18969_AP0203673</ID>
    <MemberID>I011-026-115032052-01</MemberID>
    <PayerID>INS011</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>784-1988-0593038-9</EmiratesIDNumber>
    <Gross>35.00</Gross>
    <PatientShare>7.0</PatientShare>
    <Net>28.00</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>AP0203673</PatientID>
      <Start>06/10/2023 00:00</Start>
      <End>06/10/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>M25.562</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>K21.9</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>M79.662</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>06/10/2023 00:00</Start>
      <Type>8</Type>
      <Code>9</Code>
      <Quantity>1.000</Quantity>
      <Net>28.00</Net>
      <Clinician>DHA-P-54609780</Clinician>
      <Observation>
        <Type>Result</Type>
        <Code>BPS</Code>
        <Value>120</Value>
        <ValueType>06/10/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BPD</Code>
        <Value>80</Value>
        <ValueType>06/10/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BMI</Code>
        <Value>28.28</Value>
        <ValueType>06/10/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>Weight</Code>
        <Value>77.00</Value>
        <ValueType>06/10/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>c/o pain left knee since 1 month f/b injruy while playing cricket , difficulty while bending , walking +</Value>
        <ValueType>Presenting Complaints</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>c/o heartburn , dyspepsia x 1 week</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>c/o heartburn , dyspepsia x 1 week</Value>
        <ValueType>Other</ValueType>
      </Observation>
    </Activity>
  </Claim>
</Claim.Submission>