{
  "resourceType": "Bundle",
  "id": "23ddb151-d87c-40aa-9504-0aeb627ed1b3",
  "meta": {
    "profile": [
      "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
    ]
  },
  "type": "message",
  "timestamp": "2026-10-31T15:42:19.290+03:00",
  "entry": [
    {
      "fullUrl": "http://nphies.sa/MessageHeader/0cd6e84a-390d-4228-a27e-efdf2b24b640",
      "resource": {
        "resourceType": "MessageHeader",
        "id": "0cd6e84a-390d-4228-a27e-efdf2b24b640",
        "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": "a8f791c4-02ea-4783-9e01-7edb02f55ac7",
          "code": "ok"
        }
      }
    },
    {
      "fullUrl": "http://nphies.sa/Task/7fd7dbb1-3f0c-498e-8743-f7ee15bb1384",
      "resource": {
        "resourceType": "Task",
        "id": "7fd7dbb1-3f0c-498e-8743-f7ee15bb1384",
        "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": "226"
          }
        ],
        "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": "2026-10-22T02:54:46.982+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-dab978372264"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:54:47.571+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-dab9e01d7464"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:54:48.163+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-dab9685b9f64"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:54:48.808+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-dab9e0d6ce64"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:55:29.633+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-dab980bc0765"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:55:30.254+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-dab9a8473165"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:55:31.179+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-dab990e38465"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:55:32.238+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-dab9e83af865"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:55:32.876+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-dab970641e66"
            }
          },
          {
            "extension": [
              {
                "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
                "valueDateTime": "2026-10-22T02:55:33.575+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-dab9a02f6466"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab978372264",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab978372264",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:23.462+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/a8d03728-c516-4ce1-ac90-26bb23bd16f8",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "a8d03728-c516-4ce1-ac90-26bb23bd16f8",
              "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": "4ddd8e2b-615e-4806-8813-5c19baeaf59e",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/25179956260926"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/25179956260926",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "25179956260926",
              "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-dab9e84e2264"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "professional"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/1029332"
              },
              "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": "25179956260926"
                }
              },
              "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": "98594"
                      }
                    }
                  ],
                  "itemSequence": 5,
                  "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": 20.0,
                        "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": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "MN-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33.6,
                        "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": "98594"
                      }
                    }
                  ],
                  "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": 48.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.64,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 57.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 14.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 14.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 57.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 80.64,
                        "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": "98594"
                      }
                    }
                  ],
                  "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": 16.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.88,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 19.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 19.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 26.88,
                        "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": "98594"
                      }
                    }
                  ],
                  "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": 16.0,
                        "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": 19.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.8,
                        "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": 26.88,
                        "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": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "98594"
                      }
                    }
                  ],
                  "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": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 16.8,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 184.8,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 88.8,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 33.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 33.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 132.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 13.32,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 100.0,
                    "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": "8200991"
                }
              ],
              "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/1029332"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/1029332"
              },
              "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/21645635",
                  "name": "شركة ماتش"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/1029332",
            "resource": {
              "resourceType": "Patient",
              "id": "1029332",
              "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": "1104826605"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "muhammad  ALI HASHMEY",
                  "given": [
                    "muhammad",
                    "ALI",
                    "HASHMEY"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0564542061"
                }
              ],
              "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": "1999-07-12",
              "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/21645635"
                }
              ],
              "active": true,
              "name": "شركة ماتش"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9e01d7464",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab9e01d7464",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:23.541+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/894cca8b-60e6-4651-9b89-8978e9e3d143",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "894cca8b-60e6-4651-9b89-8978e9e3d143",
              "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": "c7632812-89fe-499b-8a14-bffa32e76641",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/29179052260926"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/29179052260926",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "29179052260926",
              "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-dab9b8457464"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "professional"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/68678"
              },
              "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": "29179052260926"
                }
              },
              "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": "98179"
                      }
                    }
                  ],
                  "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": 10.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.27,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.5,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.5,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.5,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.5,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 11.27,
                        "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": "98179"
                      }
                    }
                  ],
                  "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": 30.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.82,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 25.5,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.5,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.5,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 25.5,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33.82,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 45.09,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 34.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 6.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 6.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 34.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 5.09,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 40.0,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://Medgulf.com.sa/Coverage/102"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Coverage/102",
            "resource": {
              "resourceType": "Coverage",
              "id": "102",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://www.ALKholood.com/memberid",
                  "value": "5958980"
                }
              ],
              "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/68678"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/68678"
              },
              "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/25821315",
                  "name": "شركة البلاد للاستشارات والحلول للتوظيف"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/68678",
            "resource": {
              "resourceType": "Patient",
              "id": "68678",
              "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": "1010111878"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "MISHAIL HAMADAN HAMEED ALHARBI",
                  "given": [
                    "MISHAIL",
                    "HAMEED",
                    "ALHARBI"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0508787936"
                }
              ],
              "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": "1978-07-22",
              "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/25821315"
                }
              ],
              "active": true,
              "name": "شركة البلاد للاستشارات والحلول للتوظيف"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9685b9f64",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab9685b9f64",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:23.627+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/55eb5b01-2ddf-4519-a451-35b63242145d",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "55eb5b01-2ddf-4519-a451-35b63242145d",
              "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": "1bfcc3d6-c3ae-4623-bbf0-d880dddca421",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/42182675260927"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/42182675260927",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "42182675260927",
              "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-dab958669f64"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "professional"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/909686"
              },
              "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": "42182675260927"
                }
              },
              "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": "99499"
                      }
                    }
                  ],
                  "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": 30.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33.6,
                        "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": "99499"
                      }
                    }
                  ],
                  "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": 30.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33.6,
                        "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": "99499"
                      }
                    }
                  ],
                  "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": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 16.8,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 84.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 60.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 15.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 15.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 60.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 9.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 60.0,
                    "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": "9255800"
                }
              ],
              "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/909686"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/909686"
              },
              "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/909686",
            "resource": {
              "resourceType": "Patient",
              "id": "909686",
              "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": "2618451633"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "OMAR Hussein Mohamad sulaiman",
                  "given": [
                    "OMAR",
                    "Mohamad",
                    "sulaiman"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0556761091"
                }
              ],
              "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": "1999-09-01",
              "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/24209090"
                }
              ],
              "active": true,
              "name": "شركة سراكو للموارد البشرية"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9e0d6ce64",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab9e0d6ce64",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:23.711+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/d0692319-c3fb-4f51-a150-f9649e655fe7",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "d0692319-c3fb-4f51-a150-f9649e655fe7",
              "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": "5076f2ae-7aaf-4166-8005-6aea097310b1",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/45185926260927"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/45185926260927",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "45185926260927",
              "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-dab9d0e1ce64"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "professional"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/103447"
              },
              "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": "45185926260927"
                }
              },
              "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": "100553"
                      }
                    }
                  ],
                  "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": 30.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33.6,
                        "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": "100553"
                      }
                    }
                  ],
                  "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": 10.0,
                        "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": 8.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "reason": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
                            "code": "MN-1-1"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 11.2,
                        "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": "100553"
                      }
                    }
                  ],
                  "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": 5.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.6,
                        "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": "100553"
                      }
                    }
                  ],
                  "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": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 16.8,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 67.2,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 40.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 12.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 12.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 48.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 6.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 45.0,
                    "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": "652842"
                }
              ],
              "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/103447"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/103447"
              },
              "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/24721276",
                  "name": "SAUDI SERVICES CO.LTD.AIRPORT GROUP 1 (SSCL G1)"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/103447",
            "resource": {
              "resourceType": "Patient",
              "id": "103447",
              "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": "1091461838"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "MOHSEN MASHHOR MOHSEN ALMENAMI",
                  "given": [
                    "MOHSEN",
                    "MOHSEN",
                    "ALMENAMI"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0544407911"
                }
              ],
              "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": "1993-12-09",
              "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/24721276"
                }
              ],
              "active": true,
              "name": "SAUDI SERVICES CO.LTD.AIRPORT GROUP 1 (SSCL G1)"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab980bc0765",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab980bc0765",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:23.785+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/f2a9b538-136b-47a8-8e1c-da77da526f28",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "f2a9b538-136b-47a8-8e1c-da77da526f28",
              "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": "02aa92c9-0df9-4249-98f0-0f2d4ffa094b",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/94185742260927"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/94185742260927",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "94185742260927",
              "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-dab970c70765"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "professional"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/1026203"
              },
              "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": "94185742260927"
                }
              },
              "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": "100479"
                      }
                    }
                  ],
                  "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": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 16.8,
                        "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": "100479"
                      }
                    }
                  ],
                  "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": 30.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33.6,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 50.4,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 36.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 9.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 9.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 36.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 5.4,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 30.0,
                    "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": "9777488"
                }
              ],
              "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/1026203"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/1026203"
              },
              "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/24100943",
                  "name": "شركة سالفة عطر"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/1026203",
            "resource": {
              "resourceType": "Patient",
              "id": "1026203",
              "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": "1110937099"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "algoharh  stam alsharaif",
                  "given": [
                    "algoharh",
                    "stam",
                    "alsharaif"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0508633974"
                }
              ],
              "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": "2001-01-23",
              "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/24100943"
                }
              ],
              "active": true,
              "name": "شركة سالفة عطر"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9a8473165",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab9a8473165",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:23.861+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/8986ab78-f8b6-47f4-8f19-31105f30a2e3",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "8986ab78-f8b6-47f4-8f19-31105f30a2e3",
              "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": "6fe84b87-ad9e-442d-aacf-58b629e59a87",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/34185411260927"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/34185411260927",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "34185411260927",
              "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-dab998523165"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "professional"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/1022044"
              },
              "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": "34185411260927"
                }
              },
              "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": "100383"
                      }
                    }
                  ],
                  "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": 5.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 0.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.6,
                        "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": "100383"
                      }
                    }
                  ],
                  "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": 30.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33.6,
                        "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": "100383"
                      }
                    }
                  ],
                  "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": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 16.8,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 56.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 40.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 10.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 10.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 40.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 6.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 35.0,
                    "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": "7809133"
                }
              ],
              "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/1022044"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/1022044"
              },
              "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/21408745",
                  "name": "شركة عبدالرحمن سعيد محمد العامودي شركة شخص واحد"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Patient/1022044",
            "resource": {
              "resourceType": "Patient",
              "id": "1022044",
              "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": "2215392917"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "ali abdelkhalk MUHAMMED saleh",
                  "given": [
                    "ali",
                    "MUHAMMED",
                    "saleh"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0552735515"
                }
              ],
              "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": "1982-01-01",
              "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/21408745"
                }
              ],
              "active": true,
              "name": "شركة عبدالرحمن سعيد محمد العامودي شركة شخص واحد"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab990e38465",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab990e38465",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:23.955+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/4d05350e-2f04-45cc-a4b4-fa39a90b0773",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "4d05350e-2f04-45cc-a4b4-fa39a90b0773",
              "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": "2a480f51-f28c-47f5-8d60-1dfcacd5a7f1",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/29182581260927"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/29182581260927",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "29182581260927",
              "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-dab9a0f18465"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "professional"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/75723"
              },
              "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": "29182581260927"
                }
              },
              "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": "99451"
                      }
                    }
                  ],
                  "itemSequence": 12,
                  "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": 16.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.23,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 21.57,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.43,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.43,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 21.57,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 27.23,
                        "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": "99451"
                      }
                    }
                  ],
                  "itemSequence": 11,
                  "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": 20.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.04,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 26.96,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.04,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.04,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 26.96,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 34.04,
                        "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": "99451"
                      }
                    }
                  ],
                  "itemSequence": 10,
                  "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": 16.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.23,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 21.57,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.43,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.43,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 21.57,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 27.23,
                        "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": "99451"
                      }
                    }
                  ],
                  "itemSequence": 9,
                  "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": 10.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.02,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 13.48,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.52,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.52,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 13.48,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 17.02,
                        "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": "99451"
                      }
                    }
                  ],
                  "itemSequence": 8,
                  "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": 20.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.79,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 30.0,
                        "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": 25.29,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 34.5,
                        "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": "99451"
                      }
                    }
                  ],
                  "itemSequence": 7,
                  "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": 16.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.19,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 21.57,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.43,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.43,
                        "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": 21.24,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 27.23,
                        "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": "99451"
                      }
                    }
                  ],
                  "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": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.32,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 32.35,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.65,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.65,
                        "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": 28.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 40.85,
                        "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": "99451"
                      }
                    }
                  ],
                  "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": 16.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 2.88,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 19.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 19.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 26.88,
                        "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": "approved"
                          }
                        ]
                      }
                    },
                    {
                      "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
                      "valueIdentifier": {
                        "system": "http://www.ALKholood.com/patientInvoice",
                        "value": "99451"
                      }
                    }
                  ],
                  "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": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.32,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 32.35,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.65,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.65,
                        "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": 28.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 40.85,
                        "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": "99451"
                      }
                    }
                  ],
                  "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": 8.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "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": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 13.8,
                        "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": "99451"
                      }
                    }
                  ],
                  "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": 20.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 26.96,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.04,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.04,
                        "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": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 34.04,
                        "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": "99451"
                      }
                    }
                  ],
                  "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": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 16.8,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 340.47,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 254.91,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 29.99,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 29.99,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 270.01,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 38.22,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 190.0,
                    "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": "50653421"
                }
              ],
              "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/75723"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/75723"
              },
              "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/75723",
            "resource": {
              "resourceType": "Patient",
              "id": "75723",
              "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": "2211147786"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "ALSAID MOHAMMED ABO AMAATI",
                  "given": [
                    "ALSAID",
                    "ABO",
                    "AMAATI"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0566582683"
                }
              ],
              "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": "1979-01-01",
              "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/24752479"
                }
              ],
              "active": true,
              "name": "SAUDI BINLADIN GROUP"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9e83af865",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab9e83af865",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:24.135+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/c14547ea-6514-4de6-bce9-fcc38fabb5ca",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "c14547ea-6514-4de6-bce9-fcc38fabb5ca",
              "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": "7c0c6cd1-6539-4c7a-b6b4-ffd1dfa6a3dc",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/1185311260927"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/1185311260927",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "1185311260927",
              "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-dab9884af865"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "professional"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/68783"
              },
              "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": "1185311260927"
                }
              },
              "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": "100348"
                      }
                    }
                  ],
                  "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": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 16.8,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 16.8,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 12.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 3.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 3.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 12.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 1.8,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.0,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://Medgulf.com.sa/Coverage/112"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Coverage/112",
            "resource": {
              "resourceType": "Coverage",
              "id": "112",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://www.ALKholood.com/memberid",
                  "value": "70446574"
                }
              ],
              "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/68783"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/68783"
              },
              "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/68783",
            "resource": {
              "resourceType": "Patient",
              "id": "68783",
              "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": "2119929327"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "NNGT MOHAMMED KHAIR ALMAGHRABI",
                  "given": [
                    "NNGT",
                    "KHAIR",
                    "ALMAGHRABI"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0531971168"
                }
              ],
              "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": "1995-11-27",
              "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-dab970641e66",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab970641e66",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:24.101+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/f472fb9b-87d3-4c6d-b87e-130e99c85731",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "f472fb9b-87d3-4c6d-b87e-130e99c85731",
              "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": "af0d6c43-cabd-4979-8c4b-f8efec597d9c",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/58183976260927"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/58183976260927",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "58183976260927",
              "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-dab9b8711e66"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "professional"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/117433"
              },
              "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": "58183976260927"
                }
              },
              "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": "99927"
                      }
                    }
                  ],
                  "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": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 16.8,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 16.8,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 12.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 3.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 3.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 12.0,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 1.8,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 0.0,
                    "currency": "SAR"
                  }
                }
              ],
              "insurance": [
                {
                  "sequence": 1,
                  "focal": true,
                  "coverage": {
                    "reference": "http://Medgulf.com.sa/Coverage/102"
                  }
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/Coverage/102",
            "resource": {
              "resourceType": "Coverage",
              "id": "102",
              "meta": {
                "profile": [
                  "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
                ]
              },
              "identifier": [
                {
                  "system": "http://www.ALKholood.com/memberid",
                  "value": "81045209"
                }
              ],
              "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/117433"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/117433"
              },
              "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/117433",
            "resource": {
              "resourceType": "Patient",
              "id": "117433",
              "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": "1089454704"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "LAILI  Saead ALSOBHI",
                  "given": [
                    "LAILI",
                    "Saead",
                    "ALSOBHI"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0546655781"
                }
              ],
              "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": "1993-08-20",
              "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/24752479"
                }
              ],
              "active": true,
              "name": "SAUDI BINLADIN GROUP"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "http://nphies.sa/Bundle/ba447af6-b17b-bea0-f914-dab9a02f6466",
      "resource": {
        "resourceType": "Bundle",
        "id": "ba447af6-b17b-bea0-f914-dab9a02f6466",
        "meta": {
          "profile": [
            "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
          ]
        },
        "type": "message",
        "timestamp": "2026-10-21T22:49:24.194+03:00",
        "entry": [
          {
            "fullUrl": "http://Medgulf.com.sa/MessageHeader/caabb80f-e168-403f-b4d7-489e678b4104",
            "resource": {
              "resourceType": "MessageHeader",
              "id": "caabb80f-e168-403f-b4d7-489e678b4104",
              "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": "044ebb14-afa6-402b-b934-72975abb82f2",
                "code": "ok"
              },
              "focus": [
                {
                  "reference": "http://Medgulf.com.sa/ClaimResponse/96185889260927"
                }
              ]
            }
          },
          {
            "fullUrl": "http://Medgulf.com.sa/ClaimResponse/96185889260927",
            "resource": {
              "resourceType": "ClaimResponse",
              "id": "96185889260927",
              "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-dab9e83c6466"
                }
              ],
              "status": "active",
              "type": {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                    "code": "professional"
                  }
                ]
              },
              "subType": {
                "coding": [
                  {
                    "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype",
                    "code": "op"
                  }
                ]
              },
              "use": "claim",
              "patient": {
                "reference": "http://Medgulf.com.sa/Patient/1030557"
              },
              "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": "96185889260927"
                }
              },
              "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": "100534"
                      }
                    }
                  ],
                  "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": 20.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 6.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33.6,
                        "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": "100534"
                      }
                    }
                  ],
                  "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": 24.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 4.32,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 28.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 7.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 7.2,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 28.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 40.32,
                        "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": "100534"
                      }
                    }
                  ],
                  "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": 28.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 5.04,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 8.4,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 33.6,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 47.04,
                        "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": "100534"
                      }
                    }
                  ],
                  "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": 0.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "tax"
                          }
                        ]
                      },
                      "amount": {
                        "value": 1.8,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "eligible"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                            "code": "patientShare"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "copay"
                          }
                        ]
                      },
                      "amount": {
                        "value": 3.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "benefit"
                          }
                        ]
                      },
                      "amount": {
                        "value": 12.0,
                        "currency": "SAR"
                      }
                    },
                    {
                      "category": {
                        "coding": [
                          {
                            "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                            "code": "submitted"
                          }
                        ]
                      },
                      "amount": {
                        "value": 16.8,
                        "currency": "SAR"
                      }
                    }
                  ]
                }
              ],
              "total": [
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "submitted"
                      }
                    ]
                  },
                  "amount": {
                    "value": 137.76,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "benefit"
                      }
                    ]
                  },
                  "amount": {
                    "value": 98.4,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "copay"
                      }
                    ]
                  },
                  "amount": {
                    "value": 24.6,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "patientShare"
                      }
                    ]
                  },
                  "amount": {
                    "value": 24.6,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "eligible"
                      }
                    ]
                  },
                  "amount": {
                    "value": 98.4,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://terminology.hl7.org/CodeSystem/adjudication",
                        "code": "tax"
                      }
                    ]
                  },
                  "amount": {
                    "value": 14.76,
                    "currency": "SAR"
                  }
                },
                {
                  "category": {
                    "coding": [
                      {
                        "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
                        "code": "discount"
                      }
                    ]
                  },
                  "amount": {
                    "value": 72.0,
                    "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": "9491719"
                }
              ],
              "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/1030557"
              },
              "beneficiary": {
                "reference": "http://Medgulf.com.sa/Patient/1030557"
              },
              "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/1030557",
            "resource": {
              "resourceType": "Patient",
              "id": "1030557",
              "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": "1116836527"
                }
              ],
              "active": true,
              "name": [
                {
                  "use": "official",
                  "text": "nouf Abdulaziz saleh ALZHRANE",
                  "given": [
                    "nouf",
                    "saleh",
                    "ALZHRANE"
                  ]
                }
              ],
              "telecom": [
                {
                  "system": "phone",
                  "value": "0560459870"
                }
              ],
              "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": "2002-06-26",
              "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://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"
      }
    }
  ]
}