<?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>Docmate</SenderID>
    <ReceiverID>TPA004</ReceiverID>
    <TransactionDate>28/08/2024 11:26</TransactionDate>
    <RecordCount>1</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>TPA004_INS017_28_08_2024_24754_AP0203922</ID>
    <MemberID>62D3-5833-DAA1-D53E</MemberID>
    <PayerID>INS017</PayerID>
    <ProviderID>Docmate</ProviderID>
    <EmiratesIDNumber>784-1979-9193542-7</EmiratesIDNumber>
    <Gross>514.80</Gross>
    <PatientShare>40.000</PatientShare>
    <Net>474.80</Net>
    <Encounter>
      <FacilityID>Docmate</FacilityID>
      <Type>1</Type>
      <PatientID>AP0203922</PatientID>
      <Start>28/08/2024 00:00</Start>
      <End>28/08/2024 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>K02.3</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>28/08/2024 00:00</Start>
      <Type>6</Type>
      <Code>D0150</Code>
      <Quantity>1.000</Quantity>
      <Net>34.00</Net>
      <Clinician>DHA-P-0251405</Clinician>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>28/08/2024 00:00</Start>
      <Type>6</Type>
      <Code>D3330</Code>
      <Quantity>1.000</Quantity>
      <Net>440.80</Net>
      <Clinician>DHA-P-0251405</Clinician>
    </Activity>
  </Claim>
</Claim.Submission>