<?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-P</SenderID>
    <ReceiverID>INS012</ReceiverID>
    <TransactionDate>14/04/2023 13:16</TransactionDate>
    <RecordCount>1</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>INS012_INS012_14_04_2023_1_DEMO-12</ID>
    <MemberID>wsq232</MemberID>
    <PayerID>INS012</PayerID>
    <ProviderID>DHA-P</ProviderID>
    <EmiratesIDNumber>SSA</EmiratesIDNumber>
    <Gross>312.00</Gross>
    <PatientShare>15.8</PatientShare>
    <Net>296.20</Net>
    <Encounter>
      <FacilityID>DHA-P</FacilityID>
      <Type>1</Type>
      <PatientID>DEMO-12</PatientID>
      <Start>04/04/2023 00:00</Start>
      <End>04/04/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>E27.3</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>04/04/2023 00:00</Start>
      <Type>3</Type>
      <Code>75989</Code>
      <Quantity>1.000</Quantity>
      <Net>233.00</Net>
      <Clinician>
      </Clinician>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>04/04/2023 00:00</Start>
      <Type>3</Type>
      <Code>80061</Code>
      <Quantity>1.000</Quantity>
      <Net>43.20</Net>
      <Clinician>
      </Clinician>
    </Activity>
    <Activity>
      <ID>3</ID>
      <Start>04/04/2023 00:00</Start>
      <Type>8</Type>
      <Code>9</Code>
      <Quantity>1.000</Quantity>
      <Net>20.00</Net>
      <Clinician>
      </Clinician>
    </Activity>
  </Claim>
</Claim.Submission>