<?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>INS012</ReceiverID>
    <TransactionDate>16/09/2023 14:34</TransactionDate>
    <RecordCount>2</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>INS012_INS012_16_09_2023_99_6</ID>
    <MemberID>OMAN123</MemberID>
    <PayerID>INS012</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>999-9999-9999999-9</EmiratesIDNumber>
    <Gross>96.00</Gross>
    <PatientShare>0.0</PatientShare>
    <Net>96.00</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>6</PatientID>
      <Start>07/08/2023 00:00</Start>
      <End>07/08/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>E28.2</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>A01.00</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>K03.1</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>07/08/2023 00:00</Start>
      <Type>3</Type>
      <Code>76140</Code>
      <Quantity>1.000</Quantity>
      <Net>36.00</Net>
      <Clinician>DHA-P-0240313</Clinician>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>07/08/2023 00:00</Start>
      <Type>3</Type>
      <Code>82180</Code>
      <Quantity>1.000</Quantity>
      <Net>60.00</Net>
      <Clinician>DHA-P-0240313</Clinician>
    </Activity>
  </Claim>
  <Claim>
    <ID>INS012_INS012_16_09_2023_115_DEMO-12</ID>
    <MemberID>wsq232</MemberID>
    <PayerID>INS012</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>SSA</EmiratesIDNumber>
    <Gross>411.99</Gross>
    <PatientShare>20.0</PatientShare>
    <Net>391.99</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>DEMO-12</PatientID>
      <Start>09/09/2023 00:00</Start>
      <End>09/09/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>J00</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>R50.9</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>09/09/2023 00:00</Start>
      <Type>8</Type>
      <Code>10</Code>
      <Quantity>1.000</Quantity>
      <Net>44.53</Net>
      <Clinician>
      </Clinician>
      <Observation>
        <Type>Result</Type>
        <Code>BPS</Code>
        <Value>120</Value>
        <ValueType>09/09/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BPD</Code>
        <Value>82</Value>
        <ValueType>09/09/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BMI</Code>
        <Value>22.96</Value>
        <ValueType>09/09/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>Weight</Code>
        <Value>82.00</Value>
        <ValueType>09/09/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>Back Pain</Value>
        <ValueType>Presenting Complaints</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>comnsajns</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>comnsajns</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>comnsajns</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>comnsajns</Value>
        <ValueType>Other</ValueType>
      </Observation>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>09/09/2023 00:00</Start>
      <Type>3</Type>
      <Code>70486</Code>
      <Quantity>1.000</Quantity>
      <Net>328.53</Net>
      <Clinician>
      </Clinician>
    </Activity>
    <Activity>
      <ID>3</ID>
      <Start>09/09/2023 00:00</Start>
      <Type>3</Type>
      <Code>94664</Code>
      <Quantity>1.000</Quantity>
      <Net>18.93</Net>
      <Clinician>
      </Clinician>
    </Activity>
  </Claim>
</Claim.Submission>