<?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>TPA003</ReceiverID>
    <TransactionDate>06/01/2024 17:48</TransactionDate>
    <RecordCount>3</RecordCount>
    <DispositionFlag>PRODUCTION</DispositionFlag>
  </Header>
  <Claim>
    <ID>TPA003_SP0001_06_01_2024_18239_125289</ID>
    <MemberID>1050490</MemberID>
    <PayerID>SP0001</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>784-1975-1632157-3</EmiratesIDNumber>
    <Gross>390.67</Gross>
    <PatientShare>0.0</PatientShare>
    <Net>390.67</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>125289</PatientID>
      <Start>01/10/2023 00:00</Start>
      <End>01/10/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>K29.01</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>E86.0</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>H10.011</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>H11.143</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>J20.9</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>M54.5</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>M62.830</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>R06.2</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>R11.2</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>01/10/2023 00:00</Start>
      <Type>3</Type>
      <Code>94640</Code>
      <Quantity>1.000</Quantity>
      <Net>72.45</Net>
      <Clinician>DHA-P-0240640</Clinician>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>01/10/2023 00:00</Start>
      <Type>3</Type>
      <Code>96365</Code>
      <Quantity>1.000</Quantity>
      <Net>198.72</Net>
      <Clinician>DHA-P-0240640</Clinician>
    </Activity>
    <Activity>
      <ID>3</ID>
      <Start>01/10/2023 00:00</Start>
      <Type>3</Type>
      <Code>96375</Code>
      <Quantity>1.000</Quantity>
      <Net>35.19</Net>
      <Clinician>DHA-P-0240640</Clinician>
    </Activity>
    <Activity>
      <ID>4</ID>
      <Start>01/10/2023 00:00</Start>
      <Type>8</Type>
      <Code>10.01</Code>
      <Quantity>1.000</Quantity>
      <Net>0.00</Net>
      <Clinician>DHA-P-0240640</Clinician>
      <Observation>
        <Type>Result</Type>
        <Code>BPS</Code>
        <Value>120</Value>
        <ValueType>01/10/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BPD</Code>
        <Value>80</Value>
        <ValueType>01/10/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>Weight</Code>
        <Value>79.90</Value>
        <ValueType>01/10/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>pain in abdomen with vomiting since last night h/o high grade fever with cough and bodyache and throat pain since 3 days , low back pain with right flank pain since 5 days , h/o burning and itching in eyes since 2 wk with redness of eyes on and off , discharge from eyes since 2 days</Value>
        <ValueType>Presenting Complaints</ValueType>
      </Observation>
    </Activity>
    <Activity>
      <ID>5</ID>
      <Start>01/10/2023 00:00</Start>
      <Type>5</Type>
      <Code>0011-106618-1001</Code>
      <Quantity>1.000</Quantity>
      <Net>15.33</Net>
      <Clinician>DHA-P-0240640</Clinician>
    </Activity>
    <Activity>
      <ID>6</ID>
      <Start>01/10/2023 00:00</Start>
      <Type>5</Type>
      <Code>0188-135906-2441</Code>
      <Quantity>1.000</Quantity>
      <Net>10.48</Net>
      <Clinician>DHA-P-0240640</Clinician>
    </Activity>
    <Activity>
      <ID>7</ID>
      <Start>01/10/2023 00:00</Start>
      <Type>5</Type>
      <Code>1513-242802-0801</Code>
      <Quantity>1.000</Quantity>
      <Net>42.50</Net>
      <Clinician>DHA-P-0240640</Clinician>
    </Activity>
    <Activity>
      <ID>8</ID>
      <Start>01/10/2023 00:00</Start>
      <Type>5</Type>
      <Code>0006-402805-2071</Code>
      <Quantity>1.000</Quantity>
      <Net>16.00</Net>
      <Clinician>DHA-P-0240640</Clinician>
    </Activity>
  </Claim>
  <Claim>
    <ID>TPA003_SP0001_06_01_2024_24442_60822</ID>
    <MemberID>1050424</MemberID>
    <PayerID>SP0001</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>784-1982-7532652-2</EmiratesIDNumber>
    <Gross>325.28</Gross>
    <PatientShare>55.0</PatientShare>
    <Net>270.28</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>60822</PatientID>
      <Start>07/11/2023 00:00</Start>
      <End>07/11/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>J20.9</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>R07.0</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>I10</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>K21.9</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>07/11/2023 00:00</Start>
      <Type>3</Type>
      <Code>85025</Code>
      <Quantity>1.000</Quantity>
      <Net>64.17</Net>
      <Clinician>DHA-P-0242755</Clinician>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>07/11/2023 00:00</Start>
      <Type>3</Type>
      <Code>93000</Code>
      <Quantity>1.000</Quantity>
      <Net>151.11</Net>
      <Clinician>DHA-P-0242755</Clinician>
    </Activity>
    <Activity>
      <ID>3</ID>
      <Start>07/11/2023 00:00</Start>
      <Type>8</Type>
      <Code>9</Code>
      <Quantity>1.000</Quantity>
      <Net>55.00</Net>
      <Clinician>DHA-P-0242755</Clinician>
    </Activity>
  </Claim>
  <Claim>
    <ID>TPA003_SP0001_06_01_2024_20223_118241</ID>
    <MemberID>1489144</MemberID>
    <PayerID>SP0001</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>784-1990-3981602-2</EmiratesIDNumber>
    <Gross>174.17</Gross>
    <PatientShare>50.0</PatientShare>
    <Net>124.17</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>118241</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>J20.9</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>12/10/2023 00:00</Start>
      <Type>3</Type>
      <Code>85025</Code>
      <Quantity>1.000</Quantity>
      <Net>64.17</Net>
      <Clinician>DHA-P-54609780</Clinician>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>12/10/2023 00:00</Start>
      <Type>8</Type>
      <Code>9</Code>
      <Quantity>1.000</Quantity>
      <Net>60.00</Net>
      <Clinician>DHA-P-54609780</Clinician>
      <Observation>
        <Type>Result</Type>
        <Code>BPS</Code>
        <Value>128</Value>
        <ValueType>12/10/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BPD</Code>
        <Value>80</Value>
        <ValueType>12/10/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BMI</Code>
        <Value>25.4</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>c/o cough , fever ,itchy throat since 3 days</Value>
        <ValueType>Presenting Complaints</ValueType>
      </Observation>
    </Activity>
  </Claim>
</Claim.Submission>