<?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>TPA002</ReceiverID>
    <TransactionDate>29/07/2024 15:44</TransactionDate>
    <RecordCount>1</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>TPA002_INS027_29_07_2024_24715_AP0206183</ID>
    <MemberID>ssswew</MemberID>
    <PayerID>INS027</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>999-9999-9999999-4</EmiratesIDNumber>
    <Gross>29.30</Gross>
    <PatientShare>19.300</PatientShare>
    <Net>10.00</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>AP0206183</PatientID>
      <Start>29/07/2024 00:00</Start>
      <End>29/07/2024 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>A01.03</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>A01.4</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>29/07/2024 00:00</Start>
      <Type>8</Type>
      <Code>9</Code>
      <Quantity>1.000</Quantity>
      <Net>5.70</Net>
      <Clinician>DHA-P-0243675</Clinician>
      <Observation>
        <Type>Result</Type>
        <Code>BPS</Code>
        <Value>120</Value>
        <ValueType>29/07/2024</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BPD</Code>
        <Value>82</Value>
        <ValueType>29/07/2024</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>burned skin</Value>
        <ValueType>Presenting Complaints</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>d ueyw weyuweyu</Value>
        <ValueType>Other</ValueType>
      </Observation>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>29/07/2024 00:00</Start>
      <Type>5</Type>
      <Code>0095-149911-1021</Code>
      <Quantity>1.000</Quantity>
      <Net>4.30</Net>
      <Clinician>DHA-P-0243675</Clinician>
    </Activity>
  </Claim>
</Claim.Submission>