<?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>04/05/2023 07:49</TransactionDate>
    <RecordCount>1</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>TPA002_INS017_04_05_2023_6_AP0-202937</ID>
    <MemberID>9B83-DD5F-F92A-199D</MemberID>
    <PayerID>INS017</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>784-1994-3038930-6</EmiratesIDNumber>
    <Gross>334.00</Gross>
    <PatientShare>9.0</PatientShare>
    <Net>325.00</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>AP0-202937</PatientID>
      <Start>03/05/2023 00:00</Start>
      <End>03/05/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>J06.9</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>J30.9</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>K29.70</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>R50.9</Code>
    </Diagnosis>
    <Activity>
      <ID>2</ID>
      <Start>03/05/2023 00:00</Start>
      <Type>3</Type>
      <Code>96361</Code>
      <Quantity>1.000</Quantity>
      <Net>119.00</Net>
      <Clinician>DHA-P-0242755</Clinician>
    </Activity>
    <Activity>
      <ID>4</ID>
      <Start>03/05/2023 00:00</Start>
      <Type>3</Type>
      <Code>86140</Code>
      <Quantity>1.000</Quantity>
      <Net>42.00</Net>
      <Clinician>DHA-P-0242755</Clinician>
    </Activity>
    <Activity>
      <ID>5</ID>
      <Start>03/05/2023 00:00</Start>
      <Type>3</Type>
      <Code>96365</Code>
      <Quantity>1.000</Quantity>
      <Net>86.00</Net>
      <Clinician>DHA-P-0242755</Clinician>
    </Activity>
    <Activity>
      <ID>1</ID>
      <Start>03/05/2023 00:00</Start>
      <Type>8</Type>
      <Code>9</Code>
      <Quantity>1.000</Quantity>
      <Net>36.00</Net>
      <Clinician>DHA-P-0242755</Clinician>
      <Observation>
        <Type>Result</Type>
        <Code>BPS</Code>
        <Value>130</Value>
        <ValueType>03/05/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BPD</Code>
        <Value>90</Value>
        <ValueType>03/05/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BMI</Code>
        <Value>24.51</Value>
        <ValueType>03/05/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>Weight</Code>
        <Value>70.00</Value>
        <ValueType>03/05/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>running nose and hedache and fever and throat pain 3 days has fever and weakness</Value>
        <ValueType>Presenting Complaints</ValueType>
      </Observation>
    </Activity>
    <Activity>
      <ID>3</ID>
      <Start>03/05/2023 00:00</Start>
      <Type>3</Type>
      <Code>85025</Code>
      <Quantity>1.000</Quantity>
      <Net>42.00</Net>
      <Clinician>DHA-P-0242755</Clinician>
    </Activity>
  </Claim>
</Claim.Submission>