<?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-</SenderID>
    <ReceiverID>INS012</ReceiverID>
    <TransactionDate>01/05/2023 23:32</TransactionDate>
    <RecordCount>1</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>INS012_INS012_01_05_2023_2_2</ID>
    <MemberID>123</MemberID>
    <PayerID>INS012</PayerID>
    <ProviderID>DHA-F-</ProviderID>
    <EmiratesIDNumber>999-9999-9999999-9</EmiratesIDNumber>
    <Gross>1020.00</Gross>
    <PatientShare>12.0</PatientShare>
    <Net>1008.00</Net>
    <Encounter>
      <FacilityID>DHA-F-</FacilityID>
      <Type>1</Type>
      <PatientID>2</PatientID>
      <Start>01/05/2023 00:00</Start>
      <End>01/05/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Activity>
      <ID>1</ID>
      <Start>01/05/2023 00:00</Start>
      <Type>8</Type>
      <Code>10</Code>
      <Quantity>1.000</Quantity>
      <Net>48.00</Net>
      <Clinician>
      </Clinician>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>comp</Value>
        <ValueType>Presenting Complaints</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>sasa</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>asa</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>vxv</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>xcxx</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>sad</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>sasa</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>asa</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>vxv</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>xcxx</Value>
        <ValueType>Other</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>sad</Value>
        <ValueType>Other</ValueType>
      </Observation>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>01/05/2023 00:00</Start>
      <Type>3</Type>
      <Code>70540</Code>
      <Quantity>1.000</Quantity>
      <Net>685.00</Net>
      <Clinician>
      </Clinician>
    </Activity>
    <Activity>
      <ID>3</ID>
      <Start>01/05/2023 00:00</Start>
      <Type>3</Type>
      <Code>80061</Code>
      <Quantity>1.000</Quantity>
      <Net>75.00</Net>
      <Clinician>
      </Clinician>
      <Observation>
        <Type>Result</Type>
        <Code>CHOL</Code>
        <Value>123</Value>
        <ValueType>01/05/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>TRIG</Code>
        <Value>120</Value>
        <ValueType>01/05/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>HDL</Code>
        <Value>200</Value>
        <ValueType>01/05/2023</ValueType>
      </Observation>
    </Activity>
    <Activity>
      <ID>4</ID>
      <Start>01/05/2023 00:00</Start>
      <Type>3</Type>
      <Code>76641</Code>
      <Quantity>1.000</Quantity>
      <Net>200.00</Net>
      <Clinician>
      </Clinician>
    </Activity>
  </Claim>
</Claim.Submission>