<?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>TPA003</ReceiverID>
    <TransactionDate>07/11/2024 17:00</TransactionDate>
    <RecordCount>1</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>TPA003_INS003_07_11_2024_24771_AP0206178</ID>
    <MemberID>56342374652</MemberID>
    <PayerID>INS003</PayerID>
    <ProviderID>Docmate</ProviderID>
    <EmiratesIDNumber>57333356</EmiratesIDNumber>
    <Gross>7317.90</Gross>
    <PatientShare>22.000</PatientShare>
    <Net>7295.90</Net>
    <Encounter>
      <FacilityID>Docmate</FacilityID>
      <Type>1</Type>
      <PatientID>AP0206178</PatientID>
      <Start>04/10/2024 00:00</Start>
      <End>04/10/2024 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>R21</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>04/10/2024 00:00</Start>
      <Type>8</Type>
      <Code>9</Code>
      <Quantity>1.000</Quantity>
      <Net>88.00</Net>
      <Clinician>DHA-P-0243675</Clinician>
      <Observation>
        <Type>Result</Type>
        <Code>BPS</Code>
        <Value>120</Value>
        <ValueType>04/10/2024</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BPD</Code>
        <Value>80</Value>
        <ValueType>04/10/2024</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BMI</Code>
        <Value>20.83</Value>
        <ValueType>04/10/2024</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>Weight</Code>
        <Value>66.00</Value>
        <ValueType>04/10/2024</ValueType>
      </Observation>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>04/10/2024 00:00</Start>
      <Type>5</Type>
      <Code>0095-149911-1021</Code>
      <Quantity>1.000</Quantity>
      <Net>4.30</Net>
      <Clinician>DHA-P-0243675</Clinician>
    </Activity>
    <Activity>
      <ID>3</ID>
      <Start>04/10/2024 00:00</Start>
      <Type>3</Type>
      <Code>77373</Code>
      <Quantity>1.000</Quantity>
      <Net>7203.60</Net>
      <Clinician>DHA-P-0243675</Clinician>
    </Activity>
  </Claim>
</Claim.Submission>