<?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>INS010</ReceiverID>
    <TransactionDate>14/08/2024 16:15</TransactionDate>
    <RecordCount>1</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>INS010_INS010_14_10_2023_18124_120921</ID>
    <IDPayer>12/XC/1874019</IDPayer>
    <MemberID>12/XC/31598/0/38/E/0</MemberID>
    <PayerID>INS010</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>784-1979-5829205-0</EmiratesIDNumber>
    <Gross>110.75</Gross>
    <PatientShare>0.0</PatientShare>
    <Net>110.75</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>120921</PatientID>
      <Start>30/09/2023 00:00</Start>
      <End>30/09/2023 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>E78.5</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>R60.9</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>E53.8</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>E55.9</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>M10.079</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>M62.81</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>M79.2</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>R42</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>R73.9</Code>
    </Diagnosis>
    <Activity>
      <ID>101</ID>
      <Start>30/09/2023 00:00</Start>
      <Type>8</Type>
      <Code>9.01</Code>
      <Quantity>1.000</Quantity>
      <Net>0.00</Net>
      <Clinician>DHA-P-0243675</Clinician>
      <Observation>
        <Type>Result</Type>
        <Code>BPS</Code>
        <Value>130</Value>
        <ValueType>30/09/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>BPD</Code>
        <Value>80</Value>
        <ValueType>30/09/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Result</Type>
        <Code>Weight</Code>
        <Value>100.00</Value>
        <ValueType>30/09/2023</ValueType>
      </Observation>
      <Observation>
        <Type>Text</Type>
        <Code>Presenting Complaints</Code>
        <Value>h/o,dizziness,polyuria/polydipsia,tingling/numbness-hands&amp;feet,swelling-lower ;legs,and muscle pain/weakness-6weeks
pain,and swelling-both ankle joints-2weeks
upper abdominal pain,dyspeptic symptpoms,and nausea-1week
found to have IFG,dyslipidemia,and vitamin D deficiency</Value>
        <ValueType>Presenting Complaints</ValueType>
      </Observation>
    </Activity>
    <Activity>
      <ID>102</ID>
      <Start>30/09/2023 00:00</Start>
      <Type>3</Type>
      <Code>84443</Code>
      <Quantity>1.000</Quantity>
      <Net>110.75</Net>
      <Clinician>DHA-P-0243675</Clinician>
    </Activity>
    <Resubmission>
      <Type>0</Type>
      <Comment>
      </Comment>
      <Attachment>
      </Attachment>
    </Resubmission>
  </Claim>
</Claim.Submission>