<?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>INS017</ReceiverID>
    <TransactionDate>01/07/2023 13:50</TransactionDate>
    <RecordCount>2</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>INS017_INS017_01_07_2023_67_DEMO-6</ID>
    <MemberID>1122ssd</MemberID>
    <PayerID>INS017</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>HJK</EmiratesIDNumber>
    <Gross>1605.00</Gross>
    <PatientShare>70.5</PatientShare>
    <Net>1534.50</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>DEMO-6</PatientID>
      <Start>08/06/2023 00:00</Start>
      <End>08/06/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>E40</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>A95.0</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>08/06/2023 00:00</Start>
      <Type>3</Type>
      <Code>10121</Code>
      <Quantity>1.000</Quantity>
      <Net>590.00</Net>
      <Clinician>
      </Clinician>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>08/06/2023 00:00</Start>
      <Type>3</Type>
      <Code>43273</Code>
      <Quantity>1.000</Quantity>
      <Net>490.00</Net>
      <Clinician>
      </Clinician>
    </Activity>
    <Activity>
      <ID>3</ID>
      <Start>08/06/2023 00:00</Start>
      <Type>3</Type>
      <Code>85027</Code>
      <Quantity>1.000</Quantity>
      <Net>49.50</Net>
      <Clinician>
      </Clinician>
    </Activity>
    <Activity>
      <ID>4</ID>
      <Start>08/06/2023 00:00</Start>
      <Type>3</Type>
      <Code>88321</Code>
      <Quantity>1.000</Quantity>
      <Net>405.00</Net>
      <Clinician>
      </Clinician>
    </Activity>
  </Claim>
  <Claim>
    <ID>INS017_INS017_01_07_2023_74_53</ID>
    <MemberID>656788</MemberID>
    <PayerID>INS017</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>999-9999-9999999-9</EmiratesIDNumber>
    <Gross>385.00</Gross>
    <PatientShare>77.0</PatientShare>
    <Net>308.00</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>53</PatientID>
      <Start>20/06/2023 00:00</Start>
      <End>20/06/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>A96.1</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>R52</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>20/06/2023 00:00</Start>
      <Type>8</Type>
      <Code>9</Code>
      <Quantity>1.000</Quantity>
      <Net>88.00</Net>
      <Clinician>DHA-P-0126136</Clinician>
      <Observation>
        <Type>Result</Type>
        <Code>BPS</Code>
        <Value>120</Value>
        <ValueType>20/06/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BPD</Code>
        <Value>82</Value>
        <ValueType>20/06/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BMI</Code>
        <Value>23.24</Value>
        <ValueType>20/06/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>Weight</Code>
        <Value>83.00</Value>
        <ValueType>20/06/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>fever</Value>
        <ValueType>Presenting Complaints</ValueType>
      </Observation>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>20/06/2023 00:00</Start>
      <Type>3</Type>
      <Code>10061</Code>
      <Quantity>1.000</Quantity>
      <Net>140.00</Net>
      <Clinician>DHA-P-0126136</Clinician>
    </Activity>
    <Activity>
      <ID>3</ID>
      <Start>20/06/2023 00:00</Start>
      <Type>3</Type>
      <Code>80061</Code>
      <Quantity>1.000</Quantity>
      <Net>80.00</Net>
      <Clinician>DHA-P-0126136</Clinician>
    </Activity>
  </Claim>
</Claim.Submission>