<?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>TPA004</ReceiverID>
    <TransactionDate>26/02/2024 17:55</TransactionDate>
    <RecordCount>1</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>TPA004_INS017_26_02_2024_24637_AP0203922</ID>
    <MemberID>62D3-5833-DAA1-D53E</MemberID>
    <PayerID>INS017</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>784-1979-9193542-6</EmiratesIDNumber>
    <Gross>225.33</Gross>
    <PatientShare>40.6</PatientShare>
    <Net>184.73</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>AP0203922</PatientID>
      <Start>26/02/2024 00:00</Start>
      <End>26/02/2024 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>R50.9</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>J00</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>M54.2</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>26/02/2024 00:00</Start>
      <Type>3</Type>
      <Code>80061</Code>
      <Quantity>1.000</Quantity>
      <Net>112.00</Net>
      <Clinician>DHA-P-0240256</Clinician>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>26/02/2024 00:00</Start>
      <Type>3</Type>
      <Code>96374</Code>
      <Quantity>1.000</Quantity>
      <Net>30.00</Net>
      <Clinician>DHA-P-0240256</Clinician>
    </Activity>
    <Activity>
      <ID>3</ID>
      <Start>26/02/2024 00:00</Start>
      <Type>8</Type>
      <Code>9</Code>
      <Quantity>1.000</Quantity>
      <Net>32.00</Net>
      <Clinician>DHA-P-0240256</Clinician>
      <Observation>
        <Type>Text</Type>
        <Code>Description</Code>
        <Value>PAIN RT FOOT 2 WEEKS DURATION , NO H/O TRAUMA, EARLY MORNING PAIN TO INITIATE WALKING , PAIN ON WALKING AND STANDING H/O HYPER URICEMIA H/O HEEL PAIN 11/2 YEARS</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BPS</Code>
        <Value>120</Value>
        <ValueType>26/02/2024</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BPD</Code>
        <Value>82</Value>
        <ValueType>26/02/2024</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BMI</Code>
        <Value>22.96</Value>
        <ValueType>26/02/2024</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>Weight</Code>
        <Value>82.00</Value>
        <ValueType>26/02/2024</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>PAIN RT FOOT 2 WEEKS DURATION , NO H/O TRAUMA, EARLY MORNING PAIN TO INITIATE WALKING , PAIN ON WALKING AND STANDING H/O HYPER URICEMIA H/O HEEL PAIN 11/2 YEARS</Value>
        <ValueType>Presenting Complaints</ValueType>
      </Observation>
    </Activity>
    <Activity>
      <ID>4</ID>
      <Start>26/02/2024 00:00</Start>
      <Type>5</Type>
      <Code>0011-106618-1001</Code>
      <Quantity>1.000</Quantity>
      <Net>10.73</Net>
      <Clinician>DHA-P-0240256</Clinician>
    </Activity>
  </Claim>
</Claim.Submission>