{
  "resourceType": "Bundle",
  "id": "e5b9c00a-b4dc-4e02-97c2-ad007ec606d6",
  "meta": {
    "profile": [
      "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
    ]
  },
  "type": "message",
  "timestamp": "2026-10-31T16:41:04.615+03:00",
  "entry": [
    {
      "fullUrl": "http://nphies.sa/MessageHeader/608ef064-ccbb-444e-b36c-349aedf9d9ff",
      "resource": {
        "resourceType": "MessageHeader",
        "id": "608ef064-ccbb-444e-b36c-349aedf9d9ff",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0"
          ],
          "tag": [
            {
              "system": "http://nphies.sa/terminology/CodeSystem/meta-tags",
              "code": "queued-messages"
            }
          ]
        },
        "eventCoding": {
          "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
          "code": "poll-response"
        },
        "destination": [
          {
            "endpoint": "http://nphies.sa/license/provider-license/10000300062591",
            "receiver": {
              "type": "Organization",
              "identifier": {
                "system": "http://nphies.sa/license/provider-license",
                "value": "10000300062591"
              }
            }
          }
        ],
        "sender": {
          "type": "Organization",
          "identifier": {
            "system": "http://nphies.sa/license/nphies",
            "value": "NPHIES"
          }
        },
        "source": {
          "endpoint": "http://nphies.sa/"
        },
        "response": {
          "identifier": "37d9db97-45d1-42e0-8b33-f57c09753a8e",
          "code": "ok"
        }
      }
    },
    {
      "fullUrl": "http://nphies.sa/Task/cb765a67-6a75-4ee8-912f-73ce60ad7886",
      "resource": {
        "resourceType": "Task",
        "id": "cb765a67-6a75-4ee8-912f-73ce60ad7886",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/task|1.0.0"
          ],
          "tag": [
            {
              "code": "NPHIES generated",
              "display": "NPHIES generated"
            }
          ]
        },
        "identifier": [
          {
            "system": "http://www.ALKholood.com/Task",
            "value": "357"
          }
        ],
        "status": "completed",
        "intent": "order",
        "priority": "stat",
        "code": {
          "coding": [
            {
              "system": "http://nphies.sa/terminology/CodeSystem/task-code",
              "code": "poll"
            }
          ]
        },
        "authoredOn": "2026-09-30",
        "lastModified": "2026-10-31",
        "requester": {
          "reference": "Organization/9"
        },
        "owner": {
          "identifier": {
            "system": "http://nphies.sa/license/nphies",
            "value": "NPHIES"
          }
        },
        "input": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/CodeSystem/task-input-type",
                  "code": "include-message-type"
                }
              ]
            },
            "valueCode": "claim-response"
          },
          {
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/CodeSystem/task-input-type",
                  "code": "period"
                }
              ]
            },
            "valuePeriod": {
              "start": "2026-09-30T00:00:00.000+03:00",
              "end": "2026-10-31T23:59:59.999+03:00"
            }
          },
          {
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/CodeSystem/task-input-type",
                  "code": "count"
                }
              ]
            },
            "valuePositiveInt": 10
          }
        ],
        "output": [
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:57:47.005+00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9d8ace494"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:57:47.784+00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9185d1c95"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:57:48.337+00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9b00cc595"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:57:48.985+00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab900a4f695"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:57:50.018+00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9c8e23f96"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:57:50.577+00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9907aa896"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:57:51.309+00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9f029e996"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:57:51.933+00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab980441b97"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:57:53.070+00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9e0825997"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:57:53.711+00:00"
              }
            ],
            "type": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/ValueSet/task-output-type",
                  "code": "response"
                }
              ]
            },
            "valueReference": {
              "reference": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab93868ad97"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9d8ace494",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab9d8ace494",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:35.298+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/11ac79da-84f3-4e49-a79a-092b8101b37b",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "11ac79da-84f3-4e49-a79a-092b8101b37b",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0"
                ]
              },
              "eventCoding": {
                "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
                "code": "claim-response"
              },
              "destination": [
                {
                  "endpoint": "http://www.ALKholood.com",
                  "receiver": {
                    "type": "Organization",
                    "identifier": {
                      "system": "http://nphies.sa/license/provider-license",
                      "value": "10000300062591"
                    }
                  }
                }
              ],
              "sender": {
                "type": "Organization",
                "identifier": {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001548317"
              },
              "response": {
                "identifier": "6031f9fc-778c-4abe-87a7-d22cae46e698",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/10222525260901"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/10222525260901",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "10222525260901",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-response|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                        "code": "partial"
                      }
                    ]
                  }
                },
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason",
                        "code": "other"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://Medgulf.com.sa/ClaimResponse",
                  "value": "ba447af6-b17b-bea0-f914-dab990b8e494"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/59231"
              },
              "created": "2026-10-21",
              "insurer": {
                "reference": "http://Medgulf.com.sa/Organization/10702"
              },
              "requestor": {
                "reference": "http://Medgulf.com.sa/Organization/809"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "10222525260901"
                }
              },
              "outcome": "complete",
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75345"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.46,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 32.11,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.03,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.03,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 32.11,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 40.14,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "rejected"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75345"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.91,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.55,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.64,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.64,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "MN-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.19,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 48.33,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 32.11,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 9.67,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 9.67,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 38.66,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 5.37,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://Medgulf.com.sa/Coverage/110"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Coverage/110",
            "resource": {
              "resourceType": "Coverage",
              "id": "110",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://www.ALKholood.com/memberid",
                  "value": "9445888"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL",
                    "display": "extended healthcare"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://Medgulf.com.sa/Organization/13"
              },
              "subscriber": {
                "reference": "http://Medgulf.com.sa/Patient/59231"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/59231"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self",
                    "display": "Self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://Medgulf.com.sa/Organization/10702"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "GRH/25213521",
                  "name": "Omar Saeed Aboud Bafil Sons Company Limited"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/59231",
            "resource": {
              "resourceType": "Patient",
              "id": "59231",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/occupation",
                        "code": "others"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "NI",
                        "display": "National ID"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/nationalid",
                  "value": "1087020481"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "AHMED HAMEED Ahmed ALMALKI",
                  "given": [
                    "AHMED",
                    "Ahmed",
                    "ALMALKI"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0556917090"
                }
              ],
              "gender": "male",
              "_gender": {
                "extension": [
                  {
                    "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
                    "valueCodeableConcept": {
                      "coding": [
                        {
                          "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
                          "code": "male",
                          "display": "male"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "1994-07-30",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "U"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/809",
            "resource": {
              "resourceType": "Organization",
              "id": "809",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/provider-type",
                        "code": "5",
                        "display": "Clinic"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ],
              "name": "Al-Kholood Medical Company - AlHaj"
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/10702",
            "resource": {
              "resourceType": "Organization",
              "id": "10702",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ],
              "name": "Medgulf Ins co."
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/13",
            "resource": {
              "resourceType": "Organization",
              "id": "13",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/identifier/organization",
                  "value": "GRH/25213521"
                }
              ],
              "active": true,
              "name": "Omar Saeed Aboud Bafil Sons Company Limited"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9185d1c95",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab9185d1c95",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:35.384+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/82b91525-e01d-4424-8776-f85ff3c45ad6",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "82b91525-e01d-4424-8776-f85ff3c45ad6",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0"
                ]
              },
              "eventCoding": {
                "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
                "code": "claim-response"
              },
              "destination": [
                {
                  "endpoint": "http://www.ALKholood.com",
                  "receiver": {
                    "type": "Organization",
                    "identifier": {
                      "system": "http://nphies.sa/license/provider-license",
                      "value": "10000300062591"
                    }
                  }
                }
              ],
              "sender": {
                "type": "Organization",
                "identifier": {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001548317"
              },
              "response": {
                "identifier": "d48df97f-94e9-46e5-8851-b7bcb62e74b3",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/20221927260901"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/20221927260901",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "20221927260901",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-response|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                        "code": "partial"
                      }
                    ]
                  }
                },
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason",
                        "code": "other"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://Medgulf.com.sa/ClaimResponse",
                  "value": "ba447af6-b17b-bea0-f914-dab9d86f1c95"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/1013585"
              },
              "created": "2026-10-21",
              "insurer": {
                "reference": "http://Medgulf.com.sa/Organization/10702"
              },
              "requestor": {
                "reference": "http://Medgulf.com.sa/Organization/809"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "20221927260901"
                }
              },
              "outcome": "complete",
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75101"
                      }
                    }
                  ],
                  "itemSequence": 6,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.21,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.67,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.17,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.17,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.67,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 10.84,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75101"
                      }
                    }
                  ],
                  "itemSequence": 5,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.77,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 27.1,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.78,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.78,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 27.1,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33.88,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "rejected"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75101"
                      }
                    }
                  ],
                  "itemSequence": 4,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.92,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 64.22,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 16.06,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 16.06,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "MN-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 80.28,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "partial"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75101"
                      }
                    }
                  ],
                  "itemSequence": 3,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 2.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 18.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 167.13,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.07,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.07,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "SE-1-9"
                          }
                        ]
                      },
                      "amount": {
                        "value": 73.13,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 169.2,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75101"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.63,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 11.69,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.93,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.93,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 11.69,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 14.62,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75101"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 5.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.15,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 22.68,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.67,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.67,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 22.68,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 31.75,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 340.57,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 143.27,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 35.68,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 35.68,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 301.49,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 37.48,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://Medgulf.com.sa/Coverage/107"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Coverage/107",
            "resource": {
              "resourceType": "Coverage",
              "id": "107",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://www.ALKholood.com/memberid",
                  "value": "50361504"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL",
                    "display": "extended healthcare"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://Medgulf.com.sa/Organization/13"
              },
              "subscriber": {
                "reference": "http://Medgulf.com.sa/Patient/1013585"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/1013585"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self",
                    "display": "Self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://Medgulf.com.sa/Organization/10702"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "GRH/24752479",
                  "name": "SAUDI BINLADIN GROUP"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/1013585",
            "resource": {
              "resourceType": "Patient",
              "id": "1013585",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/occupation",
                        "code": "others"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "PRC",
                        "display": "iqama"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2260454299"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "sara ali abdulsalam mahyoub",
                  "given": [
                    "sara",
                    "abdulsalam",
                    "mahyoub"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0534057393"
                }
              ],
              "gender": "female",
              "_gender": {
                "extension": [
                  {
                    "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
                    "valueCodeableConcept": {
                      "coding": [
                        {
                          "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
                          "code": "female",
                          "display": "female"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "2007-11-05",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "U"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/809",
            "resource": {
              "resourceType": "Organization",
              "id": "809",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/provider-type",
                        "code": "5",
                        "display": "Clinic"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ],
              "name": "Al-Kholood Medical Company - AlHaj"
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/10702",
            "resource": {
              "resourceType": "Organization",
              "id": "10702",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ],
              "name": "Medgulf Ins co."
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/13",
            "resource": {
              "resourceType": "Organization",
              "id": "13",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/identifier/organization",
                  "value": "GRH/24752479"
                }
              ],
              "active": true,
              "name": "SAUDI BINLADIN GROUP"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9b00cc595",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab9b00cc595",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:35.463+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/675eaf6f-d240-4ad4-9ecf-9abb2e2867fa",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "675eaf6f-d240-4ad4-9ecf-9abb2e2867fa",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0"
                ]
              },
              "eventCoding": {
                "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
                "code": "claim-response"
              },
              "destination": [
                {
                  "endpoint": "http://www.ALKholood.com",
                  "receiver": {
                    "type": "Organization",
                    "identifier": {
                      "system": "http://nphies.sa/license/provider-license",
                      "value": "10000300062591"
                    }
                  }
                }
              ],
              "sender": {
                "type": "Organization",
                "identifier": {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001548317"
              },
              "response": {
                "identifier": "7669e81e-d076-4703-a38e-e192aa2d7745",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/89222250260901"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/89222250260901",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "89222250260901",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-response|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                        "code": "partial"
                      }
                    ]
                  }
                },
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason",
                        "code": "other"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://Medgulf.com.sa/ClaimResponse",
                  "value": "ba447af6-b17b-bea0-f914-dab96818c595"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/94494"
              },
              "created": "2026-10-21",
              "insurer": {
                "reference": "http://Medgulf.com.sa/Organization/10702"
              },
              "requestor": {
                "reference": "http://Medgulf.com.sa/Organization/809"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "89222250260901"
                }
              },
              "outcome": "complete",
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75253"
                      }
                    }
                  ],
                  "itemSequence": 3,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.78,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.62,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.62,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 7.02,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75253"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.07,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 22.06,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.52,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.52,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 22.06,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 27.58,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "partial"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75253"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.78,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 19.98,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.99,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.99,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 19.97,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.97,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 59.57,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 47.65,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 11.91,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 11.91,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 47.66,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 6.63,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://Medgulf.com.sa/Coverage/106"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Coverage/106",
            "resource": {
              "resourceType": "Coverage",
              "id": "106",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://www.ALKholood.com/memberid",
                  "value": "9651359"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL",
                    "display": "extended healthcare"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://Medgulf.com.sa/Organization/13"
              },
              "subscriber": {
                "reference": "http://Medgulf.com.sa/Patient/94494"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/94494"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self",
                    "display": "Self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://Medgulf.com.sa/Organization/10702"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "GRH/25145020",
                  "name": "شركة ساعد العالمية للخدمات"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/94494",
            "resource": {
              "resourceType": "Patient",
              "id": "94494",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/occupation",
                        "code": "others"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "PRC",
                        "display": "iqama"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2588009627"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "BELAL ALSAID MOHAMMED NAQD",
                  "given": [
                    "BELAL",
                    "MOHAMMED",
                    "NAQD"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0562019099"
                }
              ],
              "gender": "male",
              "_gender": {
                "extension": [
                  {
                    "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
                    "valueCodeableConcept": {
                      "coding": [
                        {
                          "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
                          "code": "male",
                          "display": "male"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "1996-06-06",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/809",
            "resource": {
              "resourceType": "Organization",
              "id": "809",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/provider-type",
                        "code": "5",
                        "display": "Clinic"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ],
              "name": "Al-Kholood Medical Company - AlHaj"
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/10702",
            "resource": {
              "resourceType": "Organization",
              "id": "10702",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ],
              "name": "Medgulf Ins co."
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/13",
            "resource": {
              "resourceType": "Organization",
              "id": "13",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/identifier/organization",
                  "value": "GRH/25145020"
                }
              ],
              "active": true,
              "name": "شركة ساعد العالمية للخدمات"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab900a4f695",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab900a4f695",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:35.534+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/50f7c6ec-f5e8-4fd2-997c-d8098fdf7b04",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "50f7c6ec-f5e8-4fd2-997c-d8098fdf7b04",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0"
                ]
              },
              "eventCoding": {
                "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
                "code": "claim-response"
              },
              "destination": [
                {
                  "endpoint": "http://www.ALKholood.com",
                  "receiver": {
                    "type": "Organization",
                    "identifier": {
                      "system": "http://nphies.sa/license/provider-license",
                      "value": "10000300062591"
                    }
                  }
                }
              ],
              "sender": {
                "type": "Organization",
                "identifier": {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001548317"
              },
              "response": {
                "identifier": "0d23fe2f-f135-48ad-bc34-43bdec3ef12b",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/78224059260902"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/78224059260902",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "78224059260902",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-response|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                        "code": "rejected"
                      }
                    ]
                  }
                },
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason",
                        "code": "other"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://Medgulf.com.sa/ClaimResponse",
                  "value": "ba447af6-b17b-bea0-f914-dab950d1f695"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/1014117"
              },
              "created": "2026-10-21",
              "insurer": {
                "reference": "http://Medgulf.com.sa/Organization/10702"
              },
              "requestor": {
                "reference": "http://Medgulf.com.sa/Organization/809"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "78224059260902"
                }
              },
              "outcome": "complete",
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "rejected"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76044"
                      }
                    }
                  ],
                  "itemSequence": 3,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.3,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.29,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.41,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.41,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "MN-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.7,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "rejected"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76044"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 38.25,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.75,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.75,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "MN-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 45.0,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "rejected"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76044"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.91,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 22.26,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.93,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.93,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-3"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 26.19,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 73.89,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 11.09,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 11.09,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 62.8,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 8.21,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://Medgulf.com.sa/Coverage/111"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Coverage/111",
            "resource": {
              "resourceType": "Coverage",
              "id": "111",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://www.ALKholood.com/memberid",
                  "value": "8520823"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL",
                    "display": "extended healthcare"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://Medgulf.com.sa/Organization/13"
              },
              "subscriber": {
                "reference": "http://Medgulf.com.sa/Patient/1014117"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/1014117"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self",
                    "display": "Self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://Medgulf.com.sa/Organization/10702"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "GRH/22741227",
                  "name": "شركة ماجد الفطيم للسينما"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/1014117",
            "resource": {
              "resourceType": "Patient",
              "id": "1014117",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/occupation",
                        "code": "others"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "NI",
                        "display": "National ID"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/nationalid",
                  "value": "1091267540"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "ab alaziz Abdullah hussain hussain",
                  "given": [
                    "ab alaziz",
                    "hussain",
                    "hussain"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0541592155"
                }
              ],
              "gender": "male",
              "_gender": {
                "extension": [
                  {
                    "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
                    "valueCodeableConcept": {
                      "coding": [
                        {
                          "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
                          "code": "male",
                          "display": "male"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "1996-06-20",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/809",
            "resource": {
              "resourceType": "Organization",
              "id": "809",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/provider-type",
                        "code": "5",
                        "display": "Clinic"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ],
              "name": "Al-Kholood Medical Company - AlHaj"
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/10702",
            "resource": {
              "resourceType": "Organization",
              "id": "10702",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ],
              "name": "Medgulf Ins co."
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/13",
            "resource": {
              "resourceType": "Organization",
              "id": "13",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/identifier/organization",
                  "value": "GRH/22741227"
                }
              ],
              "active": true,
              "name": "شركة ماجد الفطيم للسينما"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9c8e23f96",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab9c8e23f96",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:35.711+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/341c620d-f897-4b21-b2c3-f41b1de27971",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "341c620d-f897-4b21-b2c3-f41b1de27971",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0"
                ]
              },
              "eventCoding": {
                "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
                "code": "claim-response"
              },
              "destination": [
                {
                  "endpoint": "http://www.ALKholood.com",
                  "receiver": {
                    "type": "Organization",
                    "identifier": {
                      "system": "http://nphies.sa/license/provider-license",
                      "value": "10000300062591"
                    }
                  }
                }
              ],
              "sender": {
                "type": "Organization",
                "identifier": {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001548317"
              },
              "response": {
                "identifier": "51d0a6c6-a6b1-4b5c-9c05-f7b0f2b8979d",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/96224124260902"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/96224124260902",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "96224124260902",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-response|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                        "code": "partial"
                      }
                    ]
                  }
                },
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason",
                        "code": "other"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://Medgulf.com.sa/ClaimResponse",
                  "value": "ba447af6-b17b-bea0-f914-dab970f93f96"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/1014126"
              },
              "created": "2026-10-21",
              "insurer": {
                "reference": "http://Medgulf.com.sa/Organization/10702"
              },
              "requestor": {
                "reference": "http://Medgulf.com.sa/Organization/809"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "96224124260902"
                }
              },
              "outcome": "complete",
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76079"
                      }
                    }
                  ],
                  "itemSequence": 5,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.53,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 32.62,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.15,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.15,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 32.62,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 40.77,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76079"
                      }
                    }
                  ],
                  "itemSequence": 4,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.61,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.35,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.09,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.09,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.35,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.44,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "rejected"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76079"
                      }
                    }
                  ],
                  "itemSequence": 3,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.62,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.46,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.12,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.12,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "MN-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.24,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "rejected"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76079"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.74,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.53,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.13,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.13,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "MN-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 15.66,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "rejected"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76079"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.78,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 41.62,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 10.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 10.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "MN-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 52.02,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 120.13,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 36.97,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 23.89,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 23.89,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 95.58,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 13.28,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://Medgulf.com.sa/Coverage/107"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Coverage/107",
            "resource": {
              "resourceType": "Coverage",
              "id": "107",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://www.ALKholood.com/memberid",
                  "value": "88836246"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL",
                    "display": "extended healthcare"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://Medgulf.com.sa/Organization/13"
              },
              "subscriber": {
                "reference": "http://Medgulf.com.sa/Patient/1014126"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/1014126"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self",
                    "display": "Self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://Medgulf.com.sa/Organization/10702"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "GRH/24031098",
                  "name": "MUNIF AL NAHDI - CONTRACTING"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/1014126",
            "resource": {
              "resourceType": "Patient",
              "id": "1014126",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/occupation",
                        "code": "others"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "PRC",
                        "display": "iqama"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2411338466"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "MUHAMMAD  sitare MUHAMMAD",
                  "given": [
                    "MUHAMMAD",
                    "sitare",
                    "MUHAMMAD"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0541394712"
                }
              ],
              "gender": "male",
              "_gender": {
                "extension": [
                  {
                    "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
                    "valueCodeableConcept": {
                      "coding": [
                        {
                          "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
                          "code": "male",
                          "display": "male"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "1994-01-01",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/809",
            "resource": {
              "resourceType": "Organization",
              "id": "809",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/provider-type",
                        "code": "5",
                        "display": "Clinic"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ],
              "name": "Al-Kholood Medical Company - AlHaj"
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/10702",
            "resource": {
              "resourceType": "Organization",
              "id": "10702",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ],
              "name": "Medgulf Ins co."
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/13",
            "resource": {
              "resourceType": "Organization",
              "id": "13",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/identifier/organization",
                  "value": "GRH/24031098"
                }
              ],
              "active": true,
              "name": "MUNIF AL NAHDI - CONTRACTING"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9907aa896",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab9907aa896",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:35.731+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/0b0908b0-f732-409e-bd6e-fcea342e6473",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "0b0908b0-f732-409e-bd6e-fcea342e6473",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0"
                ]
              },
              "eventCoding": {
                "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
                "code": "claim-response"
              },
              "destination": [
                {
                  "endpoint": "http://www.ALKholood.com",
                  "receiver": {
                    "type": "Organization",
                    "identifier": {
                      "system": "http://nphies.sa/license/provider-license",
                      "value": "10000300062591"
                    }
                  }
                }
              ],
              "sender": {
                "type": "Organization",
                "identifier": {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001548317"
              },
              "response": {
                "identifier": "229714e8-01ca-4b00-9f7e-465cfc6d675a",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/94224234260902"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/94224234260902",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "94224234260902",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-response|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                        "code": "partial"
                      }
                    ]
                  }
                },
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason",
                        "code": "other"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://Medgulf.com.sa/ClaimResponse",
                  "value": "ba447af6-b17b-bea0-f914-dab91087a896"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/819529"
              },
              "created": "2026-10-21",
              "insurer": {
                "reference": "http://Medgulf.com.sa/Organization/10702"
              },
              "requestor": {
                "reference": "http://Medgulf.com.sa/Organization/809"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "94224234260902"
                }
              },
              "outcome": "complete",
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76139"
                      }
                    }
                  ],
                  "itemSequence": 3,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.78,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 19.98,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.99,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.99,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 19.98,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.97,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76139"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.07,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 22.06,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.52,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.52,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 22.06,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 27.58,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "rejected"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76139"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.78,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.62,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "MN-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 7.02,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 59.57,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 42.04,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 11.91,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 11.91,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 47.66,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 6.63,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://Medgulf.com.sa/Coverage/106"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Coverage/106",
            "resource": {
              "resourceType": "Coverage",
              "id": "106",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://www.ALKholood.com/memberid",
                  "value": "9255324"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL",
                    "display": "extended healthcare"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://Medgulf.com.sa/Organization/13"
              },
              "subscriber": {
                "reference": "http://Medgulf.com.sa/Patient/819529"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/819529"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self",
                    "display": "Self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://Medgulf.com.sa/Organization/10702"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "GRH/24209090",
                  "name": "شركة سراكو للموارد البشرية"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/819529",
            "resource": {
              "resourceType": "Patient",
              "id": "819529",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/occupation",
                        "code": "others"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "PRC",
                        "display": "iqama"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2615542848"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "MUHAMMAD ABRAHEM  abdulhameed",
                  "given": [
                    "MUHAMMAD",
                    "abdulhameed",
                    "abdulhameed"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0507601855"
                }
              ],
              "gender": "male",
              "_gender": {
                "extension": [
                  {
                    "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
                    "valueCodeableConcept": {
                      "coding": [
                        {
                          "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
                          "code": "male",
                          "display": "male"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "1987-09-08",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/809",
            "resource": {
              "resourceType": "Organization",
              "id": "809",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/provider-type",
                        "code": "5",
                        "display": "Clinic"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ],
              "name": "Al-Kholood Medical Company - AlHaj"
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/10702",
            "resource": {
              "resourceType": "Organization",
              "id": "10702",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ],
              "name": "Medgulf Ins co."
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/13",
            "resource": {
              "resourceType": "Organization",
              "id": "13",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/identifier/organization",
                  "value": "GRH/24209090"
                }
              ],
              "active": true,
              "name": "شركة سراكو للموارد البشرية"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9f029e996",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab9f029e996",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:35.825+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/f748cb13-b9cb-4be7-9a6c-f6ab34b154a7",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "f748cb13-b9cb-4be7-9a6c-f6ab34b154a7",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0"
                ]
              },
              "eventCoding": {
                "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
                "code": "claim-response"
              },
              "destination": [
                {
                  "endpoint": "http://www.ALKholood.com",
                  "receiver": {
                    "type": "Organization",
                    "identifier": {
                      "system": "http://nphies.sa/license/provider-license",
                      "value": "10000300062591"
                    }
                  }
                }
              ],
              "sender": {
                "type": "Organization",
                "identifier": {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001548317"
              },
              "response": {
                "identifier": "d6e9f812-8307-418b-9f7f-d5caf1e1ff9b",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/47224546260902"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/47224546260902",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "47224546260902",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-response|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                        "code": "approved"
                      }
                    ]
                  }
                },
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason",
                        "code": "other"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://Medgulf.com.sa/ClaimResponse",
                  "value": "ba447af6-b17b-bea0-f914-dab9a835e996"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/67760"
              },
              "created": "2026-10-21",
              "insurer": {
                "reference": "http://Medgulf.com.sa/Organization/10702"
              },
              "requestor": {
                "reference": "http://Medgulf.com.sa/Organization/809"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "47224546260902"
                }
              },
              "outcome": "complete",
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76235"
                      }
                    }
                  ],
                  "itemSequence": 3,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 5.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.73,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 60.52,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 60.52,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 60.52,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76235"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 3.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 17.07,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 123.63,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 30.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 30.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 122.9,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 153.63,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "76235"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 3.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 31.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 286.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 228.96,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 286.2,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 500.35,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 412.38,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 30.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 30.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 470.35,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 55.6,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://Medgulf.com.sa/Coverage/107"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Coverage/107",
            "resource": {
              "resourceType": "Coverage",
              "id": "107",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://www.ALKholood.com/memberid",
                  "value": "50335060"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL",
                    "display": "extended healthcare"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://Medgulf.com.sa/Organization/13"
              },
              "subscriber": {
                "reference": "http://Medgulf.com.sa/Patient/67760"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/67760"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self",
                    "display": "Self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://Medgulf.com.sa/Organization/10702"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "GRH/25383621",
                  "name": "الشركة الخليجية الأولى للتعهدات والمقاولات"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/67760",
            "resource": {
              "resourceType": "Patient",
              "id": "67760",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/occupation",
                        "code": "others"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "PRC",
                        "display": "iqama"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2052295108"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "SAMIR HEIDER AHMED ALNAHARI",
                  "given": [
                    "SAMIR",
                    "AHMED",
                    "ALNAHARI"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0550666764"
                }
              ],
              "gender": "male",
              "_gender": {
                "extension": [
                  {
                    "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
                    "valueCodeableConcept": {
                      "coding": [
                        {
                          "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
                          "code": "male",
                          "display": "male"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "1985-03-22",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "U"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/809",
            "resource": {
              "resourceType": "Organization",
              "id": "809",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/provider-type",
                        "code": "5",
                        "display": "Clinic"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ],
              "name": "Al-Kholood Medical Company - AlHaj"
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/10702",
            "resource": {
              "resourceType": "Organization",
              "id": "10702",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ],
              "name": "Medgulf Ins co."
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/13",
            "resource": {
              "resourceType": "Organization",
              "id": "13",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/identifier/organization",
                  "value": "GRH/25383621"
                }
              ],
              "active": true,
              "name": "الشركة الخليجية الأولى للتعهدات والمقاولات"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab980441b97",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab980441b97",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:35.898+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/dfd15bb1-79f8-4ef6-bbc4-6bd57ccf1a24",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "dfd15bb1-79f8-4ef6-bbc4-6bd57ccf1a24",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0"
                ]
              },
              "eventCoding": {
                "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
                "code": "claim-response"
              },
              "destination": [
                {
                  "endpoint": "http://www.ALKholood.com",
                  "receiver": {
                    "type": "Organization",
                    "identifier": {
                      "system": "http://nphies.sa/license/provider-license",
                      "value": "10000300062591"
                    }
                  }
                }
              ],
              "sender": {
                "type": "Organization",
                "identifier": {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001548317"
              },
              "response": {
                "identifier": "cedbda85-1fcc-4848-825d-45b5bcfd5db1",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/63223890260902"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/63223890260902",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "63223890260902",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-response|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                        "code": "partial"
                      }
                    ]
                  }
                },
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason",
                        "code": "other"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://Medgulf.com.sa/ClaimResponse",
                  "value": "ba447af6-b17b-bea0-f914-dab938501b97"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/75640"
              },
              "created": "2026-10-21",
              "insurer": {
                "reference": "http://Medgulf.com.sa/Organization/10702"
              },
              "requestor": {
                "reference": "http://Medgulf.com.sa/Organization/809"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "63223890260902"
                }
              },
              "outcome": "complete",
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "rejected"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75936"
                      }
                    }
                  ],
                  "itemSequence": 3,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.46,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 32.07,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.02,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.02,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "MN-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 40.09,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75936"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.83,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 99.34,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 16.13,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 16.13,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "BE-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 92.38,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 115.47,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75936"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.25,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 23.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.85,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.85,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 23.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 29.25,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 184.81,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 115.78,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 30.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 30.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 154.81,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 20.54,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://Medgulf.com.sa/Coverage/107"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Coverage/107",
            "resource": {
              "resourceType": "Coverage",
              "id": "107",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://www.ALKholood.com/memberid",
                  "value": "9651067"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL",
                    "display": "extended healthcare"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://Medgulf.com.sa/Organization/13"
              },
              "subscriber": {
                "reference": "http://Medgulf.com.sa/Patient/75640"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/75640"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self",
                    "display": "Self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://Medgulf.com.sa/Organization/10702"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "GRH/25145020",
                  "name": "شركة ساعد العالمية للخدمات"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/75640",
            "resource": {
              "resourceType": "Patient",
              "id": "75640",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/occupation",
                        "code": "others"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "PRC",
                        "display": "iqama"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2587655115"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "AHMED ABDULAAL MOHAMMED ALI",
                  "given": [
                    "AHMED",
                    "MOHAMMED",
                    "ALI"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0547641780"
                }
              ],
              "gender": "male",
              "_gender": {
                "extension": [
                  {
                    "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
                    "valueCodeableConcept": {
                      "coding": [
                        {
                          "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
                          "code": "male",
                          "display": "male"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "1987-05-04",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/809",
            "resource": {
              "resourceType": "Organization",
              "id": "809",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/provider-type",
                        "code": "5",
                        "display": "Clinic"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ],
              "name": "Al-Kholood Medical Company - AlHaj"
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/10702",
            "resource": {
              "resourceType": "Organization",
              "id": "10702",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ],
              "name": "Medgulf Ins co."
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/13",
            "resource": {
              "resourceType": "Organization",
              "id": "13",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/identifier/organization",
                  "value": "GRH/25145020"
                }
              ],
              "active": true,
              "name": "شركة ساعد العالمية للخدمات"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9e0825997",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab9e0825997",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:35.978+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/0fe5da96-6c91-40e8-a964-e348345e61d8",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "0fe5da96-6c91-40e8-a964-e348345e61d8",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0"
                ]
              },
              "eventCoding": {
                "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
                "code": "claim-response"
              },
              "destination": [
                {
                  "endpoint": "http://www.ALKholood.com",
                  "receiver": {
                    "type": "Organization",
                    "identifier": {
                      "system": "http://nphies.sa/license/provider-license",
                      "value": "10000300062591"
                    }
                  }
                }
              ],
              "sender": {
                "type": "Organization",
                "identifier": {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001548317"
              },
              "response": {
                "identifier": "10488718-7ce8-4893-818c-7359ed0f8632",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/49223938260902"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/49223938260902",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "49223938260902",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-response|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                        "code": "partial"
                      }
                    ]
                  }
                },
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason",
                        "code": "other"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://Medgulf.com.sa/ClaimResponse",
                  "value": "ba447af6-b17b-bea0-f914-dab9988e5997"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/65632"
              },
              "created": "2026-10-21",
              "insurer": {
                "reference": "http://Medgulf.com.sa/Organization/10702"
              },
              "requestor": {
                "reference": "http://Medgulf.com.sa/Organization/809"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "49223938260902"
                }
              },
              "outcome": "complete",
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75968"
                      }
                    }
                  ],
                  "itemSequence": 4,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.51,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.63,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.91,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.91,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.63,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.54,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "partial"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75968"
                      }
                    }
                  ],
                  "itemSequence": 3,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 2.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.58,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 18.58,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.64,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.64,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "SE-1-9"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.68,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 23.22,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75968"
                      }
                    }
                  ],
                  "itemSequence": 2,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.52,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 10.9,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.73,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.73,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 10.9,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 13.63,
                        "currency": "SAR"
                      }
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "rejected"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75968"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 0.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.78,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 41.62,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 10.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 10.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "MN-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 52.02,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 93.41,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 20.21,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 18.68,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 18.68,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 74.73,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 10.39,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://Medgulf.com.sa/Coverage/107"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Coverage/107",
            "resource": {
              "resourceType": "Coverage",
              "id": "107",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://www.ALKholood.com/memberid",
                  "value": "9649990"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL",
                    "display": "extended healthcare"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://Medgulf.com.sa/Organization/13"
              },
              "subscriber": {
                "reference": "http://Medgulf.com.sa/Patient/65632"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/65632"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self",
                    "display": "Self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://Medgulf.com.sa/Organization/10702"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "GRH/25145020",
                  "name": "شركة ساعد العالمية للخدمات"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/65632",
            "resource": {
              "resourceType": "Patient",
              "id": "65632",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/occupation",
                        "code": "others"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "PRC",
                        "display": "iqama"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/iqama",
                  "value": "2585477611"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "AHMED ALI FAROUK ALI",
                  "given": [
                    "AHMED",
                    "FAROUK",
                    "ALI"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0560652493"
                }
              ],
              "gender": "male",
              "_gender": {
                "extension": [
                  {
                    "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
                    "valueCodeableConcept": {
                      "coding": [
                        {
                          "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
                          "code": "male",
                          "display": "male"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "1997-09-25",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/809",
            "resource": {
              "resourceType": "Organization",
              "id": "809",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/provider-type",
                        "code": "5",
                        "display": "Clinic"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ],
              "name": "Al-Kholood Medical Company - AlHaj"
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/10702",
            "resource": {
              "resourceType": "Organization",
              "id": "10702",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ],
              "name": "Medgulf Ins co."
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/13",
            "resource": {
              "resourceType": "Organization",
              "id": "13",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/identifier/organization",
                  "value": "GRH/25145020"
                }
              ],
              "active": true,
              "name": "شركة ساعد العالمية للخدمات"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab93868ad97",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab93868ad97",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:36.156+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/3d4d2f5f-ac57-4bba-aa74-47d690cb400d",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "3d4d2f5f-ac57-4bba-aa74-47d690cb400d",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0"
                ]
              },
              "eventCoding": {
                "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events",
                "code": "claim-response"
              },
              "destination": [
                {
                  "endpoint": "http://www.ALKholood.com",
                  "receiver": {
                    "type": "Organization",
                    "identifier": {
                      "system": "http://nphies.sa/license/provider-license",
                      "value": "10000300062591"
                    }
                  }
                }
              ],
              "sender": {
                "type": "Organization",
                "identifier": {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              },
              "source": {
                "endpoint": "http://nphies.sa/license/payer-license/7001548317"
              },
              "response": {
                "identifier": "b705f93c-912e-47e3-b156-84409fca9493",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/43223927260902"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/43223927260902",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "43223927260902",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/claim-response|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                        "code": "approved"
                      }
                    ]
                  }
                },
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason",
                        "code": "other"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://Medgulf.com.sa/ClaimResponse",
                  "value": "ba447af6-b17b-bea0-f914-dab9f073ad97"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "pharmacy"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/91830"
              },
              "created": "2026-10-21",
              "insurer": {
                "reference": "http://Medgulf.com.sa/Organization/10702"
              },
              "requestor": {
                "reference": "http://Medgulf.com.sa/Organization/809"
              },
              "request": {
                "type": "Claim",
                "identifier": {
                  "system": "http://www.ALKholood.com/claim",
                  "value": "43223927260902"
                }
              },
              "outcome": "complete",
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
                            "code": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "75962"
                      }
                    }
                  ],
                  "itemSequence": 1,
                  "adjudication": [
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "approved-quantity"
                          }
                        ]
                      },
                      "value": 1.0
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "discount"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.78,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.62,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.62,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 7.02,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 7.02,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 5.62,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 1.4,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 1.4,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 5.62,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.78,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://Medgulf.com.sa/Coverage/106"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Coverage/106",
            "resource": {
              "resourceType": "Coverage",
              "id": "106",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://www.ALKholood.com/memberid",
                  "value": "554211"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
                    "code": "EHCPOL",
                    "display": "extended healthcare"
                  }
                ]
              },
              "policyHolder": {
                "reference": "http://Medgulf.com.sa/Organization/13"
              },
              "subscriber": {
                "reference": "http://Medgulf.com.sa/Patient/91830"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/91830"
              },
              "relationship": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                    "code": "self",
                    "display": "Self"
                  }
                ]
              },
              "payor": [
                {
                  "reference": "http://Medgulf.com.sa/Organization/10702"
                }
              ],
              "class": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                        "code": "plan"
                      }
                    ]
                  },
                  "value": "GRH/24752479",
                  "name": "SAUDI BINLADIN GROUP"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/91830",
            "resource": {
              "resourceType": "Patient",
              "id": "91830",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/occupation",
                        "code": "others"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "type": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "NI",
                        "display": "National ID"
                      }
                    ]
                  },
                  "system": "http://nphies.sa/identifier/nationalid",
                  "value": "1039250228"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "HODA SAOUD SUWAED ALLAHIBI",
                  "given": [
                    "HODA",
                    "SUWAED",
                    "ALLAHIBI"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0582069021"
                }
              ],
              "gender": "female",
              "_gender": {
                "extension": [
                  {
                    "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
                    "valueCodeableConcept": {
                      "coding": [
                        {
                          "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
                          "code": "female",
                          "display": "female"
                        }
                      ]
                    }
                  }
                ]
              },
              "birthDate": "1985-02-04",
              "maritalStatus": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
                    "code": "M"
                  }
                ]
              }
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/809",
            "resource": {
              "resourceType": "Organization",
              "id": "809",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0"
                ]
              },
              "extension": [
                {
                  "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/provider-type",
                        "code": "5",
                        "display": "Clinic"
                      }
                    ]
                  }
                }
              ],
              "identifier": [
                {
                  "system": "http://nphies.sa/license/provider-license",
                  "value": "10000300062591"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "prov"
                    }
                  ]
                }
              ],
              "name": "Al-Kholood Medical Company - AlHaj"
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/10702",
            "resource": {
              "resourceType": "Organization",
              "id": "10702",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/license/payer-license",
                  "value": "7001548317"
                }
              ],
              "active": true,
              "type": [
                {
                  "coding": [
                    {
                      "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                      "code": "ins"
                    }
                  ]
                }
              ],
              "name": "Medgulf Ins co."
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Organization/13",
            "resource": {
              "resourceType": "Organization",
              "id": "13",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://nphies.sa/identifier/organization",
                  "value": "GRH/24752479"
                }
              ],
              "active": true,
              "name": "SAUDI BINLADIN GROUP"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://www.ALKholood.com/Organization/9",
      "resource": {
        "resourceType": "Organization",
        "id": "9",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0"
          ]
        },
        "extension": [
          {
            "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
            "valueCodeableConcept": {
              "coding": [
                {
                  "system": "http://nphies.sa/terminology/CodeSystem/provider-type",
                  "code": "5",
                  "display": "Clinic"
                }
              ]
            }
          }
        ],
        "identifier": [
          {
            "use": "official",
            "system": "http://nphies.sa/license/provider-license",
            "value": "10000300062591"
          }
        ],
        "active": true,
        "type": [
          {
            "coding": [
              {
                "system": "http://nphies.sa/terminology/CodeSystem/organization-type",
                "code": "prov"
              }
            ]
          }
        ],
        "name": "Al-Kholood Medical Company - AlHaj"
      }
    }
  ]
}