{ "resourceType": "Bundle", "id": "328f682a-395f-4838-9906-eda3ed6fd62b", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-31T14:57:42.850+03:00", "entry": [ { "fullUrl": "http://nphies.sa/MessageHeader/1dbdee29-877a-4f4c-a049-20a92277e95d", "resource": { "resourceType": "MessageHeader", "id": "1dbdee29-877a-4f4c-a049-20a92277e95d", "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": "7450011c-e1a3-4046-bf4a-01029f36fa5a", "code": "ok" } } }, { "fullUrl": "http://nphies.sa/Task/ae626ef6-eb8a-4b97-a678-b9d980504126", "resource": { "resourceType": "Task", "id": "ae626ef6-eb8a-4b97-a678-b9d980504126", "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": "988" } ], "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": "2026-10-20T08:55:22.315+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/675719c1-d6d9-49e5-b383-a37adbbad217" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:22.317+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/e2ef6f98-bb44-43d8-b0e4-10a64c491fb1" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:22.489+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/b75ff552-d651-439c-8317-6f7cac0f13df" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:22.603+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/8eacea99-f186-4315-8cfc-33294c5e6241" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:22.610+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/c19bc4d3-d2f0-4113-90b5-6b65e582c68a" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:22.640+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/a5247d06-9029-483f-96b7-97f65c0b5366" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:22.658+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/5e8c54c5-e170-408e-b179-6bd4f01fb0d3" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:22.668+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/f1840949-0a23-490d-8167-ad68f94c587d" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:22.674+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/862d7772-9cd5-4d8d-ba03-19e8f2561a39" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:22.692+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/1e8544a3-3ef1-4fdb-ad2e-f19f2642d02f" } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/675719c1-d6d9-49e5-b383-a37adbbad217", "resource": { "resourceType": "Bundle", "id": "675719c1-d6d9-49e5-b383-a37adbbad217", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:21.799+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/01efdd44-157c-48f3-8362-0e4cdfab665d", "resource": { "resourceType": "MessageHeader", "id": "01efdd44-157c-48f3-8362-0e4cdfab665d", "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": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "5b606c0b-5b8d-4279-a792-581e1cee573a", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/022017b0-0013-4514-b7de-75fc17e3c6e0" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/022017b0-0013-4514-b7de-75fc17e3c6e0", "resource": { "resourceType": "ClaimResponse", "id": "022017b0-0013-4514-b7de-75fc17e3c6e0", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-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": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "1511" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "022017b0-0013-4514-b7de-75fc17e3c6e0" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/24efaee9-df97-4a5e-b554-ee2f175c63f1" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/695130a1-0f14-4bfd-ad78-c5c7986122e3" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/d1189f19-6ffe-4258-8200-9bd72c7a5028" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "30261596260918" } }, "outcome": "complete", "disposition": "-", "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": "91282" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 11.11, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 11.11, "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, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 2.22, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 0 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "rejected" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "91282" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 10.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 52.02, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 52.02, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "reason": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason", "code": "AD-2-4" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 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-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "91282" } } ], "itemSequence": 3, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 6.24, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 6.24, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.12, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 4.46, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "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": "91282" } } ], "itemSequence": 4, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 31.41, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 6.28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 31.41, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 25.13, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "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": "91282" } } ], "itemSequence": 5, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 40.77, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 8.15, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 40.77, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "reason": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason", "code": "AD-2-4" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 0 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 141.55, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 29.59, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 28.17, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 141.55, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/889addc2-27b3-4bdf-aeb0-d2c073b43747" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/24efaee9-df97-4a5e-b554-ee2f175c63f1", "resource": { "resourceType": "Patient", "id": "24efaee9-df97-4a5e-b554-ee2f175c63f1", "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": "2320079375" } ], "active": true, "name": [ { "use": "official", "text": "NADAA MOHAMMED Ayub bahch", "given": [ "NADAA", "Ayub", "bahch" ] } ], "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": "2002-11-14", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/d1189f19-6ffe-4258-8200-9bd72c7a5028", "resource": { "resourceType": "Organization", "id": "d1189f19-6ffe-4258-8200-9bd72c7a5028", "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": "https://tawuniya.com.sa/Organization/695130a1-0f14-4bfd-ad78-c5c7986122e3", "resource": { "resourceType": "Organization", "id": "695130a1-0f14-4bfd-ad78-c5c7986122e3", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/889addc2-27b3-4bdf-aeb0-d2c073b43747", "resource": { "resourceType": "Coverage", "id": "889addc2-27b3-4bdf-aeb0-d2c073b43747", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002042847141241" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/46fc76aa-c770-4ff0-bef5-f4d3b88581c1" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/5f3af87e-7646-4d86-ace6-89c98dcac593" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/24efaee9-df97-4a5e-b554-ee2f175c63f1" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/695130a1-0f14-4bfd-ad78-c5c7986122e3" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "50077051", "name": "Pillars Investment Company" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/46fc76aa-c770-4ff0-bef5-f4d3b88581c1", "resource": { "resourceType": "Organization", "id": "46fc76aa-c770-4ff0-bef5-f4d3b88581c1", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/5f3af87e-7646-4d86-ace6-89c98dcac593", "resource": { "resourceType": "Patient", "id": "5f3af87e-7646-4d86-ace6-89c98dcac593", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2320079375" } ], "active": true, "name": [ { "use": "official", "text": "NADAA MOHAMMED Ayub bahch", "given": [ "NADAA", "Ayub", "bahch" ] } ], "telecom": [ { "system": "phone", "value": "0537342067" } ], "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": "2002-11-14", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/e2ef6f98-bb44-43d8-b0e4-10a64c491fb1", "resource": { "resourceType": "Bundle", "id": "e2ef6f98-bb44-43d8-b0e4-10a64c491fb1", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:21.873+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/4a833766-5597-453f-91d9-5d9f4ec92400", "resource": { "resourceType": "MessageHeader", "id": "4a833766-5597-453f-91d9-5d9f4ec92400", "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": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "f9356df2-8559-46bc-ad6a-1ea6a6b0a313", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/0c1d9ab0-6942-4a48-a043-62d57a3547a2" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/0c1d9ab0-6942-4a48-a043-62d57a3547a2", "resource": { "resourceType": "ClaimResponse", "id": "0c1d9ab0-6942-4a48-a043-62d57a3547a2", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-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": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "2457" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "0c1d9ab0-6942-4a48-a043-62d57a3547a2" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/0ada3e73-70c1-4416-a38f-db1665a6c62d" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/3ff94edd-918d-4e52-b9c1-bef80ebb906b" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/3a0ebfed-6b53-49fc-af5f-1afc9b7cd28f" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "48287924260928" } }, "outcome": "complete", "disposition": "-", "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": "101232" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 5.62, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 7.02, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 7.02, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "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": "101232" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 22.06, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5.52, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 27.58, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 27.58, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 34.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 27.68, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 6.92, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 34.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/7ad90f88-6524-4a6e-a448-7bdd2482edee" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/0ada3e73-70c1-4416-a38f-db1665a6c62d", "resource": { "resourceType": "Patient", "id": "0ada3e73-70c1-4416-a38f-db1665a6c62d", "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": "2408040216" } ], "active": true, "name": [ { "use": "official", "text": "javed javed ABDU ALSTAR", "given": [ "javed", "ABDU", "ALSTAR" ] } ], "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": "1975-02-06", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/3a0ebfed-6b53-49fc-af5f-1afc9b7cd28f", "resource": { "resourceType": "Organization", "id": "3a0ebfed-6b53-49fc-af5f-1afc9b7cd28f", "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": "https://tawuniya.com.sa/Organization/3ff94edd-918d-4e52-b9c1-bef80ebb906b", "resource": { "resourceType": "Organization", "id": "3ff94edd-918d-4e52-b9c1-bef80ebb906b", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/7ad90f88-6524-4a6e-a448-7bdd2482edee", "resource": { "resourceType": "Coverage", "id": "7ad90f88-6524-4a6e-a448-7bdd2482edee", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002408040216001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/147329d9-f6dc-4546-a4d5-d5285d74d8c9" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/c0bb1d61-1266-4dda-93b5-6b5936863136" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/0ada3e73-70c1-4416-a38f-db1665a6c62d" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/3ff94edd-918d-4e52-b9c1-bef80ebb906b" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "53171265", "name": "AL THAKEB FOR TRADING INV CO" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/147329d9-f6dc-4546-a4d5-d5285d74d8c9", "resource": { "resourceType": "Organization", "id": "147329d9-f6dc-4546-a4d5-d5285d74d8c9", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/c0bb1d61-1266-4dda-93b5-6b5936863136", "resource": { "resourceType": "Patient", "id": "c0bb1d61-1266-4dda-93b5-6b5936863136", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2408040216" } ], "active": true, "name": [ { "use": "official", "text": "javed javed ABDU ALSTAR", "given": [ "javed", "ABDU", "ALSTAR" ] } ], "telecom": [ { "system": "phone", "value": "0596923743" } ], "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": "1975-02-06", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/b75ff552-d651-439c-8317-6f7cac0f13df", "resource": { "resourceType": "Bundle", "id": "b75ff552-d651-439c-8317-6f7cac0f13df", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:21.759+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/d224bb6e-55b6-439a-b4d3-f6a3dff9c676", "resource": { "resourceType": "MessageHeader", "id": "d224bb6e-55b6-439a-b4d3-f6a3dff9c676", "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": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "a622e50b-bc90-45f5-98fb-1111422c5d21", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/6db27220-dc67-4317-b72f-12c0622bed7b" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/6db27220-dc67-4317-b72f-12c0622bed7b", "resource": { "resourceType": "ClaimResponse", "id": "6db27220-dc67-4317-b72f-12c0622bed7b", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-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": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "1529" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "6db27220-dc67-4317-b72f-12c0622bed7b" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/260dbc5e-f65e-415d-a0ff-a55b6eb2e702" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/6f13a64f-0b8c-4adf-9aac-daf1d59f156d" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/5ddf1632-5846-42cc-9407-df7bc6c5186f" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "63262130260919" } }, "outcome": "complete", "disposition": "-", "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": "91551" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 7.02, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 8.77, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 8.77, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.75, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "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": "91551" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 5.98, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.49, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 7.47, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 7.47, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 16.24, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 13, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 3.24, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 16.24, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/bc4994e0-003d-4d4d-b4a4-ad36f39d0d8d" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/260dbc5e-f65e-415d-a0ff-a55b6eb2e702", "resource": { "resourceType": "Patient", "id": "260dbc5e-f65e-415d-a0ff-a55b6eb2e702", "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": "2010602577" } ], "active": true, "name": [ { "use": "official", "text": "NASER ALDIEN HASAN HMIDAH", "given": [ "NASER", "HASAN", "HMIDAH" ] } ], "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": "1958-07-01", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/5ddf1632-5846-42cc-9407-df7bc6c5186f", "resource": { "resourceType": "Organization", "id": "5ddf1632-5846-42cc-9407-df7bc6c5186f", "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": "https://tawuniya.com.sa/Organization/6f13a64f-0b8c-4adf-9aac-daf1d59f156d", "resource": { "resourceType": "Organization", "id": "6f13a64f-0b8c-4adf-9aac-daf1d59f156d", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/bc4994e0-003d-4d4d-b4a4-ad36f39d0d8d", "resource": { "resourceType": "Coverage", "id": "bc4994e0-003d-4d4d-b4a4-ad36f39d0d8d", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002010602577001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/d57da467-f50b-4fd0-969b-43293232c047" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/eb5fb45d-ed68-49a5-8f7f-43b8d89a7592" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/260dbc5e-f65e-415d-a0ff-a55b6eb2e702" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/6f13a64f-0b8c-4adf-9aac-daf1d59f156d" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "57901572", "name": "Asloob Al Omran Engi Basic B" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/d57da467-f50b-4fd0-969b-43293232c047", "resource": { "resourceType": "Organization", "id": "d57da467-f50b-4fd0-969b-43293232c047", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/eb5fb45d-ed68-49a5-8f7f-43b8d89a7592", "resource": { "resourceType": "Patient", "id": "eb5fb45d-ed68-49a5-8f7f-43b8d89a7592", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2010602577" } ], "active": true, "name": [ { "use": "official", "text": "NASER ALDIEN HASAN HMIDAH", "given": [ "NASER", "HASAN", "HMIDAH" ] } ], "telecom": [ { "system": "phone", "value": "0506529218" } ], "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": "1958-07-01", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/8eacea99-f186-4315-8cfc-33294c5e6241", "resource": { "resourceType": "Bundle", "id": "8eacea99-f186-4315-8cfc-33294c5e6241", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:21.745+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/d64cf300-9923-4383-a130-eeeb84587159", "resource": { "resourceType": "MessageHeader", "id": "d64cf300-9923-4383-a130-eeeb84587159", "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": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "6cc495ea-2ce9-456e-b0c2-6a526d8dbff1", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/4f57a101-fb5a-4d6f-8b6b-dd432a58421a" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/4f57a101-fb5a-4d6f-8b6b-dd432a58421a", "resource": { "resourceType": "ClaimResponse", "id": "4f57a101-fb5a-4d6f-8b6b-dd432a58421a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-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": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "1185" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "4f57a101-fb5a-4d6f-8b6b-dd432a58421a" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/31e8717b-6efa-40b3-9d7d-9385877ef058" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/9d945370-12f4-4cf6-984a-ddace299ca07" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/a278f8cc-209a-461e-a85d-ea3c682ebaa3" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "76252610260914" } }, "outcome": "complete", "disposition": "-", "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": "87877" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 24.48, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 30.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 6.12, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 30.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "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": "87877" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 14.62, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 2.92, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 14.62, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 11.7, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "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": "87877" } } ], "itemSequence": 3, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 25.65, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20.52, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5.13, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 25.65, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 70.87, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 56.7, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 14.17, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 70.87, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/9f5482b3-a6bd-4a02-b08e-2e77f72a8767" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/31e8717b-6efa-40b3-9d7d-9385877ef058", "resource": { "resourceType": "Patient", "id": "31e8717b-6efa-40b3-9d7d-9385877ef058", "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": "1074562610" } ], "active": true, "name": [ { "use": "official", "text": "amany SALEM AHMED ALHAGAGI", "given": [ "amany", "AHMED", "ALHAGAGI" ] } ], "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": "1991-10-16", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/a278f8cc-209a-461e-a85d-ea3c682ebaa3", "resource": { "resourceType": "Organization", "id": "a278f8cc-209a-461e-a85d-ea3c682ebaa3", "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": "https://tawuniya.com.sa/Organization/9d945370-12f4-4cf6-984a-ddace299ca07", "resource": { "resourceType": "Organization", "id": "9d945370-12f4-4cf6-984a-ddace299ca07", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/9f5482b3-a6bd-4a02-b08e-2e77f72a8767", "resource": { "resourceType": "Coverage", "id": "9f5482b3-a6bd-4a02-b08e-2e77f72a8767", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "001074562610001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/2d1ee4fb-8993-49cf-a285-0e972b4b9c5f" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/f33d4ef4-4c65-4a9a-966a-d5c1061cb2da" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/31e8717b-6efa-40b3-9d7d-9385877ef058" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/9d945370-12f4-4cf6-984a-ddace299ca07" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "52683367", "name": "Swiss Time Trading C Basic B" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/2d1ee4fb-8993-49cf-a285-0e972b4b9c5f", "resource": { "resourceType": "Organization", "id": "2d1ee4fb-8993-49cf-a285-0e972b4b9c5f", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/f33d4ef4-4c65-4a9a-966a-d5c1061cb2da", "resource": { "resourceType": "Patient", "id": "f33d4ef4-4c65-4a9a-966a-d5c1061cb2da", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1074562610" } ], "active": true, "name": [ { "use": "official", "text": "amany SALEM AHMED ALHAGAGI", "given": [ "amany", "AHMED", "ALHAGAGI" ] } ], "telecom": [ { "system": "phone", "value": "0550121285" } ], "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": "1991-10-16", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/c19bc4d3-d2f0-4113-90b5-6b65e582c68a", "resource": { "resourceType": "Bundle", "id": "c19bc4d3-d2f0-4113-90b5-6b65e582c68a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:22.230+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/2fa89303-6339-43d2-957a-cfb7acf10f29", "resource": { "resourceType": "MessageHeader", "id": "2fa89303-6339-43d2-957a-cfb7acf10f29", "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": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "2a0e6baf-0b7d-4026-8387-7fae9d551d0d", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/1aa845fb-9206-446c-9835-3e169b5830c4" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/1aa845fb-9206-446c-9835-3e169b5830c4", "resource": { "resourceType": "ClaimResponse", "id": "1aa845fb-9206-446c-9835-3e169b5830c4", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-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": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "908" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "1aa845fb-9206-446c-9835-3e169b5830c4" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/f4bb2578-0c98-45cf-951e-9b88a0f6351f" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/6c09c83a-8c0d-4100-bf68-da6030541101" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/bbd5c7a0-e5b2-49df-85e4-92e6e41827fc" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "18244598260912" } }, "outcome": "complete", "disposition": "-", "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": "84790" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 26.32, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 26.32, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 26.32, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 26.32, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 26.32, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 26.32, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/aa50dabd-5976-4018-b19d-34b7fc5c25c9" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/f4bb2578-0c98-45cf-951e-9b88a0f6351f", "resource": { "resourceType": "Patient", "id": "f4bb2578-0c98-45cf-951e-9b88a0f6351f", "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": "1058741891" } ], "active": true, "name": [ { "use": "official", "text": "ATEF SAEED ABDULLAH ALSOBHI", "given": [ "ATEF", "ABDULLAH", "ALSOBHI" ] } ], "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": "1979-03-21", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/bbd5c7a0-e5b2-49df-85e4-92e6e41827fc", "resource": { "resourceType": "Organization", "id": "bbd5c7a0-e5b2-49df-85e4-92e6e41827fc", "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": "https://tawuniya.com.sa/Organization/6c09c83a-8c0d-4100-bf68-da6030541101", "resource": { "resourceType": "Organization", "id": "6c09c83a-8c0d-4100-bf68-da6030541101", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/aa50dabd-5976-4018-b19d-34b7fc5c25c9", "resource": { "resourceType": "Coverage", "id": "aa50dabd-5976-4018-b19d-34b7fc5c25c9", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "001058741891001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/75ad09cf-ff3d-4982-8384-c67976bb9cda" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/a907f407-0e0c-4c10-bc4d-655427cff015" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/f4bb2578-0c98-45cf-951e-9b88a0f6351f" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/6c09c83a-8c0d-4100-bf68-da6030541101" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "50906666", "name": "NAZAHA" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/75ad09cf-ff3d-4982-8384-c67976bb9cda", "resource": { "resourceType": "Organization", "id": "75ad09cf-ff3d-4982-8384-c67976bb9cda", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/a907f407-0e0c-4c10-bc4d-655427cff015", "resource": { "resourceType": "Patient", "id": "a907f407-0e0c-4c10-bc4d-655427cff015", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1058741891" } ], "active": true, "name": [ { "use": "official", "text": "ATEF SAEED ABDULLAH ALSOBHI", "given": [ "ATEF", "ABDULLAH", "ALSOBHI" ] } ], "telecom": [ { "system": "phone", "value": "0596277593" } ], "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": "1979-03-21", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/a5247d06-9029-483f-96b7-97f65c0b5366", "resource": { "resourceType": "Bundle", "id": "a5247d06-9029-483f-96b7-97f65c0b5366", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:22.206+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/8e59fc36-931f-40f9-bc58-a46c5ecc43af", "resource": { "resourceType": "MessageHeader", "id": "8e59fc36-931f-40f9-bc58-a46c5ecc43af", "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": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "980e2995-fc15-4c96-9498-f94e2bdccbdd", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/4f1ad331-abd9-445f-8c21-00c475d6fbf7" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/4f1ad331-abd9-445f-8c21-00c475d6fbf7", "resource": { "resourceType": "ClaimResponse", "id": "4f1ad331-abd9-445f-8c21-00c475d6fbf7", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-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": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "503" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "4f1ad331-abd9-445f-8c21-00c475d6fbf7" } ], "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": "https://tawuniya.com.sa/Patient/0806af6d-7cc5-4d9f-8513-d2508fadae5c" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/e35edd90-01c6-429e-b00d-6e44111d74b5" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/bb7cc920-4368-41ed-af57-1c30a101c1f3" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "75133710260907" } }, "outcome": "complete", "disposition": "-", "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": "80448" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/5fe48acc-c1fa-4780-a3ee-52174a14737d" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/0806af6d-7cc5-4d9f-8513-d2508fadae5c", "resource": { "resourceType": "Patient", "id": "0806af6d-7cc5-4d9f-8513-d2508fadae5c", "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": "1019588860" } ], "active": true, "name": [ { "use": "official", "text": "AHMED BAKAR MOHAMMED FALATAH", "given": [ "AHMED", "MOHAMMED", "FALATAH" ] } ], "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": "1971-09-20", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/bb7cc920-4368-41ed-af57-1c30a101c1f3", "resource": { "resourceType": "Organization", "id": "bb7cc920-4368-41ed-af57-1c30a101c1f3", "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": "https://tawuniya.com.sa/Organization/e35edd90-01c6-429e-b00d-6e44111d74b5", "resource": { "resourceType": "Organization", "id": "e35edd90-01c6-429e-b00d-6e44111d74b5", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/5fe48acc-c1fa-4780-a3ee-52174a14737d", "resource": { "resourceType": "Coverage", "id": "5fe48acc-c1fa-4780-a3ee-52174a14737d", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "001019588860001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/1756bd00-a8f6-44f4-a43c-13c4d491e241" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/cac5cad5-693c-4083-a1ef-99b4395fc6c8" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/0806af6d-7cc5-4d9f-8513-d2508fadae5c" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/e35edd90-01c6-429e-b00d-6e44111d74b5" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "55054131", "name": "Modern Bus Company Limited" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/1756bd00-a8f6-44f4-a43c-13c4d491e241", "resource": { "resourceType": "Organization", "id": "1756bd00-a8f6-44f4-a43c-13c4d491e241", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/cac5cad5-693c-4083-a1ef-99b4395fc6c8", "resource": { "resourceType": "Patient", "id": "cac5cad5-693c-4083-a1ef-99b4395fc6c8", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1019588860" } ], "active": true, "name": [ { "use": "official", "text": "AHMED BAKAR MOHAMMED FALATAH", "given": [ "AHMED", "MOHAMMED", "FALATAH" ] } ], "telecom": [ { "system": "phone", "value": "0551232311" } ], "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": "1971-09-20", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/5e8c54c5-e170-408e-b179-6bd4f01fb0d3", "resource": { "resourceType": "Bundle", "id": "5e8c54c5-e170-408e-b179-6bd4f01fb0d3", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:22.360+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/d9be3896-3d2c-4ff5-8d70-b0ae4d0bb15f", "resource": { "resourceType": "MessageHeader", "id": "d9be3896-3d2c-4ff5-8d70-b0ae4d0bb15f", "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": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "14afbe1a-918b-4e77-a200-4d27ed04a2c7", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/5354b150-1e2d-4e49-baee-b21169ebbe3a" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/5354b150-1e2d-4e49-baee-b21169ebbe3a", "resource": { "resourceType": "ClaimResponse", "id": "5354b150-1e2d-4e49-baee-b21169ebbe3a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-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": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "461" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "5354b150-1e2d-4e49-baee-b21169ebbe3a" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/a264cb77-f501-4c1c-bf41-f58c80d3bd46" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/142bbea0-6156-4dbf-993a-4c3dcc8df8fb" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/7bfb126b-8aaf-4f70-98cc-9904e09f1f36" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "61232767260906" } }, "outcome": "complete", "disposition": "-", "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": "80009" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 7.38, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.48, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 5.9, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 7.38, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 7.38, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 5.9, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.48, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 7.38, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/27af8bf8-ac08-44dd-8946-aa5e9cf1e832" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/a264cb77-f501-4c1c-bf41-f58c80d3bd46", "resource": { "resourceType": "Patient", "id": "a264cb77-f501-4c1c-bf41-f58c80d3bd46", "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": "1223627264" } ], "active": true, "name": [ { "use": "official", "text": "allaa ABRAHEM sulaiman almahyawi", "given": [ "allaa", "sulaiman", "almahyawi" ] } ], "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": "2026-07-17", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/7bfb126b-8aaf-4f70-98cc-9904e09f1f36", "resource": { "resourceType": "Organization", "id": "7bfb126b-8aaf-4f70-98cc-9904e09f1f36", "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": "https://tawuniya.com.sa/Organization/142bbea0-6156-4dbf-993a-4c3dcc8df8fb", "resource": { "resourceType": "Organization", "id": "142bbea0-6156-4dbf-993a-4c3dcc8df8fb", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/27af8bf8-ac08-44dd-8946-aa5e9cf1e832", "resource": { "resourceType": "Coverage", "id": "27af8bf8-ac08-44dd-8946-aa5e9cf1e832", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "001081599126201" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/1163b430-e044-4031-81b1-9add817ac2d2" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/d2d06a71-e91e-47ca-953d-fd72519af31f" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/a264cb77-f501-4c1c-bf41-f58c80d3bd46" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/142bbea0-6156-4dbf-993a-4c3dcc8df8fb" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "51792955", "name": "MAJESTIC INTERNATIONAL COMPANY LLC" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/1163b430-e044-4031-81b1-9add817ac2d2", "resource": { "resourceType": "Organization", "id": "1163b430-e044-4031-81b1-9add817ac2d2", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/d2d06a71-e91e-47ca-953d-fd72519af31f", "resource": { "resourceType": "Patient", "id": "d2d06a71-e91e-47ca-953d-fd72519af31f", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1223627264" } ], "active": true, "name": [ { "use": "official", "text": "allaa ABRAHEM sulaiman almahyawi", "given": [ "allaa", "sulaiman", "almahyawi" ] } ], "telecom": [ { "system": "phone", "value": "0548841431" } ], "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": "2026-07-17", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/f1840949-0a23-490d-8167-ad68f94c587d", "resource": { "resourceType": "Bundle", "id": "f1840949-0a23-490d-8167-ad68f94c587d", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:22.235+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/93d2d8b8-fc6c-4101-a9ab-ef3660fc6136", "resource": { "resourceType": "MessageHeader", "id": "93d2d8b8-fc6c-4101-a9ab-ef3660fc6136", "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": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "a774f441-f6c2-4e9e-9cdc-ee008a66bad7", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/ee86b060-b0b0-421e-a6f5-6e5d2f7f4360" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/ee86b060-b0b0-421e-a6f5-6e5d2f7f4360", "resource": { "resourceType": "ClaimResponse", "id": "ee86b060-b0b0-421e-a6f5-6e5d2f7f4360", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-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": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "915" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "ee86b060-b0b0-421e-a6f5-6e5d2f7f4360" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/4b3a87c4-675c-4375-8f46-65a603aa17e1" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/76549bc2-da26-42bb-ac35-28d28fd6ad12" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/1afedf31-fa26-4cef-8ec2-f00732bda5ff" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "40244932260912" } }, "outcome": "complete", "disposition": "-", "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": "84924" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 15.12, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 22.68, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 2.27, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 22.68, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 4.54, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "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": "84924" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 2.27, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 15.12, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 3.78, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 18.9, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 18.9, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 41.58, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 30.24, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 8.32, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 41.58, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 4.54, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/37f816c7-ad29-419e-a132-7ec89da86fe0" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/4b3a87c4-675c-4375-8f46-65a603aa17e1", "resource": { "resourceType": "Patient", "id": "4b3a87c4-675c-4375-8f46-65a603aa17e1", "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": "1070829088" } ], "active": true, "name": [ { "use": "official", "text": "ASMAA ABDULAZIZ ABED ALSAEDI", "given": [ "ASMAA", "ABED", "ALSAEDI" ] } ], "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": "1990-02-26", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/1afedf31-fa26-4cef-8ec2-f00732bda5ff", "resource": { "resourceType": "Organization", "id": "1afedf31-fa26-4cef-8ec2-f00732bda5ff", "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": "https://tawuniya.com.sa/Organization/76549bc2-da26-42bb-ac35-28d28fd6ad12", "resource": { "resourceType": "Organization", "id": "76549bc2-da26-42bb-ac35-28d28fd6ad12", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/37f816c7-ad29-419e-a132-7ec89da86fe0", "resource": { "resourceType": "Coverage", "id": "37f816c7-ad29-419e-a132-7ec89da86fe0", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "001052870449101" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/215ef4a3-a110-4ba5-8dad-f22ab78c872f" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/3e576e12-d27f-4559-94d8-8198a2d5587a" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/4b3a87c4-675c-4375-8f46-65a603aa17e1" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/76549bc2-da26-42bb-ac35-28d28fd6ad12" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "50610345", "name": "Abu Al Jadayel Beverages Factory" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/215ef4a3-a110-4ba5-8dad-f22ab78c872f", "resource": { "resourceType": "Organization", "id": "215ef4a3-a110-4ba5-8dad-f22ab78c872f", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/3e576e12-d27f-4559-94d8-8198a2d5587a", "resource": { "resourceType": "Patient", "id": "3e576e12-d27f-4559-94d8-8198a2d5587a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1070829088" } ], "active": true, "name": [ { "use": "official", "text": "ASMAA ABDULAZIZ ABED ALSAEDI", "given": [ "ASMAA", "ABED", "ALSAEDI" ] } ], "telecom": [ { "system": "phone", "value": "0533176166" } ], "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": "1990-02-26", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/862d7772-9cd5-4d8d-ba03-19e8f2561a39", "resource": { "resourceType": "Bundle", "id": "862d7772-9cd5-4d8d-ba03-19e8f2561a39", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:22.097+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/7caebe4e-e1dc-42e3-b988-151cca89a98b", "resource": { "resourceType": "MessageHeader", "id": "7caebe4e-e1dc-42e3-b988-151cca89a98b", "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": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "f1fc44eb-a2e8-430b-bac8-74b7d874e239", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/26e5e941-d4d6-44f9-93a3-723533d392ef" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/26e5e941-d4d6-44f9-93a3-723533d392ef", "resource": { "resourceType": "ClaimResponse", "id": "26e5e941-d4d6-44f9-93a3-723533d392ef", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-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": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "744" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "26e5e941-d4d6-44f9-93a3-723533d392ef" } ], "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": "https://tawuniya.com.sa/Patient/249b4ebd-c599-4d90-8ac6-970aa1ff5cb9" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/5bc7e266-1251-4ad9-a845-c9116c667757" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/31588203-6e83-4e37-9826-7b3c4186c8d8" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "21140269260909" } }, "outcome": "complete", "disposition": "-", "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": "82897" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 20, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "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": "82897" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 30.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 3.3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 22, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 30.8, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5.5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "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": "82897" } } ], "itemSequence": 3, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 92.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 92.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "reason": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason", "code": "AD-1-4" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 16.5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 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-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "82897" } } ], "itemSequence": 4, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 24.64, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 24.64, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 4.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 17.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 2.64, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "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": "82897" } } ], "itemSequence": 5, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 2.64, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 24.64, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 4.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 24.64, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 17.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "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": "82897" } } ], "itemSequence": 6, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 92.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 16.5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 92.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 66, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 9.9, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 292.88, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 143.2, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 52.3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 292.88, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 21.48, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/0d696235-d6fe-4dc0-bc10-31f7b34946f5" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/249b4ebd-c599-4d90-8ac6-970aa1ff5cb9", "resource": { "resourceType": "Patient", "id": "249b4ebd-c599-4d90-8ac6-970aa1ff5cb9", "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": "1057696591" } ], "active": true, "name": [ { "use": "official", "text": "USAMA GHAZALI فطاني", "given": [ "USAMA", "فطاني", "فطاني" ] } ], "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": "1986-12-21", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/31588203-6e83-4e37-9826-7b3c4186c8d8", "resource": { "resourceType": "Organization", "id": "31588203-6e83-4e37-9826-7b3c4186c8d8", "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": "https://tawuniya.com.sa/Organization/5bc7e266-1251-4ad9-a845-c9116c667757", "resource": { "resourceType": "Organization", "id": "5bc7e266-1251-4ad9-a845-c9116c667757", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/0d696235-d6fe-4dc0-bc10-31f7b34946f5", "resource": { "resourceType": "Coverage", "id": "0d696235-d6fe-4dc0-bc10-31f7b34946f5", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "001057696591001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/4854787e-3806-416f-aeea-0507a5dfa365" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/a3335408-5032-4eb2-a9df-4e980493f07f" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/249b4ebd-c599-4d90-8ac6-970aa1ff5cb9" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/5bc7e266-1251-4ad9-a845-c9116c667757" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "55082618", "name": "ALKHORAYEF INDUSTRIES COMPANY" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/4854787e-3806-416f-aeea-0507a5dfa365", "resource": { "resourceType": "Organization", "id": "4854787e-3806-416f-aeea-0507a5dfa365", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/a3335408-5032-4eb2-a9df-4e980493f07f", "resource": { "resourceType": "Patient", "id": "a3335408-5032-4eb2-a9df-4e980493f07f", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1057696591" } ], "active": true, "name": [ { "use": "official", "text": "USAMA GHAZALI فطاني", "given": [ "USAMA", "فطاني", "فطاني" ] } ], "telecom": [ { "system": "phone", "value": "0555225997" } ], "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": "1986-12-21", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/1e8544a3-3ef1-4fdb-ad2e-f19f2642d02f", "resource": { "resourceType": "Bundle", "id": "1e8544a3-3ef1-4fdb-ad2e-f19f2642d02f", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:20.777+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/5789dc51-2d6b-402d-b137-c6018a5d289b", "resource": { "resourceType": "MessageHeader", "id": "5789dc51-2d6b-402d-b137-c6018a5d289b", "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": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "e4ebe2d7-2b0f-426f-9e4d-d173180e9385", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/2c60dc88-78dd-490c-8e3d-c0dc7e6876e3" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/2c60dc88-78dd-490c-8e3d-c0dc7e6876e3", "resource": { "resourceType": "ClaimResponse", "id": "2c60dc88-78dd-490c-8e3d-c0dc7e6876e3", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-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": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "2245" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "2c60dc88-78dd-490c-8e3d-c0dc7e6876e3" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/c42357db-58d9-4985-9735-4628a3d55aec" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/a87433f3-e312-492e-b12b-77828fa6a009" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/7116d2a2-d40c-497c-a1c2-3b90dfb47d6f" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "23281623260926" } }, "outcome": "complete", "disposition": "-", "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": "99133" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "reason": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason", "code": "AD-2-4" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 7.02, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 7.02, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 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-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "99133" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 24.97, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 4.99, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 24.97, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 19.98, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "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": "99133" } } ], "itemSequence": 3, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 8.19, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "reason": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason", "code": "AD-2-4" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.64, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 8.19, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 0 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 40.18, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 19.98, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 8.03, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 40.18, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/7dfa2f39-cfcf-4794-96eb-b3f9d2c32274" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/c42357db-58d9-4985-9735-4628a3d55aec", "resource": { "resourceType": "Patient", "id": "c42357db-58d9-4985-9735-4628a3d55aec", "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": "2556668206" } ], "active": true, "name": [ { "use": "official", "text": "ABDULAZIZ MOHAMMED HAMED IBRAHIM", "given": [ "ABDULAZIZ", "HAMED", "IBRAHIM" ] } ], "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": "1971-01-18", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/7116d2a2-d40c-497c-a1c2-3b90dfb47d6f", "resource": { "resourceType": "Organization", "id": "7116d2a2-d40c-497c-a1c2-3b90dfb47d6f", "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": "https://tawuniya.com.sa/Organization/a87433f3-e312-492e-b12b-77828fa6a009", "resource": { "resourceType": "Organization", "id": "a87433f3-e312-492e-b12b-77828fa6a009", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/7dfa2f39-cfcf-4794-96eb-b3f9d2c32274", "resource": { "resourceType": "Coverage", "id": "7dfa2f39-cfcf-4794-96eb-b3f9d2c32274", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002556668206001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/c04b0334-5b44-4363-b211-4fae05cef4b7" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/d9386224-f9dc-4810-809f-86a88b842c1a" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/c42357db-58d9-4985-9735-4628a3d55aec" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/a87433f3-e312-492e-b12b-77828fa6a009" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "58851495", "name": "Creative generation International Co" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/c04b0334-5b44-4363-b211-4fae05cef4b7", "resource": { "resourceType": "Organization", "id": "c04b0334-5b44-4363-b211-4fae05cef4b7", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/d9386224-f9dc-4810-809f-86a88b842c1a", "resource": { "resourceType": "Patient", "id": "d9386224-f9dc-4810-809f-86a88b842c1a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2556668206" } ], "active": true, "name": [ { "use": "official", "text": "ABDULAZIZ MOHAMMED HAMED IBRAHIM", "given": [ "ABDULAZIZ", "HAMED", "IBRAHIM" ] } ], "telecom": [ { "system": "phone", "value": "0568308311" } ], "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": "1971-01-18", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "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" } } ] }