<?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>03/06/2023 13:47</TransactionDate>
    <RecordCount>2</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>INS012_INS012_03_06_2023_30_DEMO-12</ID>
    <MemberID>wsq232</MemberID>
    <PayerID>INS012</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>SSA</EmiratesIDNumber>
    <Gross>717.00</Gross>
    <PatientShare>20.0</PatientShare>
    <Net>697.00</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>DEMO-12</PatientID>
      <Start>13/05/2023 00:00</Start>
      <End>13/05/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>E27.3</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>E27.8</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>G44.83</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>J01.00</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>J30.9</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>M24.611</Code>
    </Diagnosis>
    <Activity>
      <ID>2</ID>
      <Start>13/05/2023 00:00</Start>
      <Type>3</Type>
      <Code>72196</Code>
      <Quantity>1.000</Quantity>
      <Net>652.00</Net>
      <Clinician>DHA-P-0126136</Clinician>
    </Activity>
    <Activity>
      <ID>1</ID>
      <Start>13/05/2023 00:00</Start>
      <Type>8</Type>
      <Code>10</Code>
      <Quantity>1.000</Quantity>
      <Net>45.00</Net>
      <Clinician>DHA-P-0126136</Clinician>
      <Observation>
        <Type>Result</Type>
        <Code>BPS</Code>
        <Value>120</Value>
        <ValueType>13/05/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BPD</Code>
        <Value>80</Value>
        <ValueType>13/05/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BMI</Code>
        <Value>19.78</Value>
        <ValueType>13/05/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>Weight</Code>
        <Value>50.00</Value>
        <ValueType>13/05/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>FBS</Code>
        <Value>125.00</Value>
        <ValueType>13/05/2023</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>
    </Activity>
  </Claim>
  <Claim>
    <ID>INS012_INS012_03_06_2023_53_DEMO-13</ID>
    <MemberID>ada</MemberID>
    <PayerID>INS012</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>999-9999-9999999-9</EmiratesIDNumber>
    <Gross>25.00</Gross>
    <PatientShare>5.0</PatientShare>
    <Net>20.00</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>DEMO-13</PatientID>
      <Start>26/05/2023 00:00</Start>
      <End>26/05/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Activity>
      <ID>1</ID>
      <Start>26/05/2023 00:00</Start>
      <Type>8</Type>
      <Code>9</Code>
      <Quantity>1.000</Quantity>
      <Net>20.00</Net>
      <Clinician>DHA-P-0126136</Clinician>
    </Activity>
  </Claim>
</Claim.Submission>