Error Al-Kholood Medical Company - AlHaj claim-response
All traces- Trace
- 1fee38ea-b0a4-44bf-9656-e7a9d01535d1
- Started
- 2026-10-31 13:13:23.140 +03:00
- Branch
- Al-Kholood Medical Company - AlHaj (9)
- Mode
- Middleware
- Service URL
- https://nphies.careofme.net/api/v1/nphies/send
- HTTP
- 200 in 1501 ms
- Bundle / Request
- e846dc13-1e3d-48c9-a38b-11b5fda94046 / 761611
- Parsed items
- 0
- Total duration
- 1503 ms
- Error
- Cannot open database "NitcoSysLog" requested by the login. The login failed. Login failed for user 'NitcoWebcenter'.
{
"resourceType": "Bundle",
"id": "e846dc13-1e3d-48c9-a38b-11b5fda94046",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-31T13:13:23.14\u002B03:00",
"entry": [
{
"fullUrl": "urn:uuid:ff094f20-6ba4-4e3b-8ce6-8afc22d294c5",
"resource": {
"resourceType": "MessageHeader",
"id": "ff094f20-6ba4-4e3b-8ce6-8afc22d294c5",
"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": "poll-request"
},
"destination": [
{
"endpoint": "http://nphies.sa",
"receiver": {
"type": "Organization",
"identifier": {
"system": "http://nphies.sa/license/nphies",
"value": "NPHIES"
}
}
}
],
"sender": {
"type": "Organization",
"identifier": {
"system": "http://nphies.sa/license/provider-license",
"value": "10000300062591"
}
},
"source": {
"endpoint": "http://nphies.sa/license/provider-license/10000300062591"
},
"focus": [
{
"reference": "http://www.ALKholood.com/Task/761611"
}
]
}
},
{
"fullUrl": "http://www.ALKholood.com/Task/761611",
"resource": {
"resourceType": "Task",
"id": "761611",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/task|1.0.0"
]
},
"identifier": [
{
"use": "official",
"system": "http://www.ALKholood.com/Task",
"value": "PlReq_920261031131323"
}
],
"status": "requested",
"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\u002B03:00",
"end": "2026-10-31T23:59:59.999\u002B03:00"
}
},
{
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/task-input-type",
"code": "count"
}
]
},
"valuePositiveInt": 10
}
]
}
},
{
"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"
}
}
]
}
The middleware wrapper exactly as posted. MessageBody is elided
because it is only base64 of the FHIR bundle on the Request tab.
{
"Credentials": {
"user": "TEMP-NNIC-PROV",
"password": "TEMP-NNIC-PROV",
"providerno": "10000300062591"
},
"MessageBody": "\u003Cbase64 of the FHIR bundle omitted \u2014 3840 chars\u003E",
"BundleID": "e846dc13-1e3d-48c9-a38b-11b5fda94046"
}
{
"resourceType": "Bundle",
"id": "9c24275e-300d-4933-8968-e3a695f31ae8",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-31T13:13:24.501\u002B03:00",
"entry": [
{
"fullUrl": "http://nphies.sa/MessageHeader/f1694911-c5bd-422c-a031-d27bef3e304e",
"resource": {
"resourceType": "MessageHeader",
"id": "f1694911-c5bd-422c-a031-d27bef3e304e",
"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": "ff094f20-6ba4-4e3b-8ce6-8afc22d294c5",
"code": "ok"
}
}
},
{
"fullUrl": "http://nphies.sa/Task/0014e1cc-7ecb-45a1-b9a4-608c937337cc",
"resource": {
"resourceType": "Task",
"id": "0014e1cc-7ecb-45a1-b9a4-608c937337cc",
"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": "797"
}
],
"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\u002B03:00",
"end": "2026-10-31T23:59:59.999\u002B03:00"
}
},
{
"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": "2026-10-20T08:55:12.294\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/af94e717-488c-4049-aa6e-6fed1953f3e2"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.294\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/eb07b1d8-a7d4-4064-8152-ba975e2e3be3"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.303\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/117cd5e7-2608-464f-a259-efec684311aa"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.313\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/06cf103f-e188-406e-a9da-c129adfc725d"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.329\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/40975dc9-f4fd-48be-b900-e18267269528"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.343\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/42ea93fb-e8a9-4c89-984a-f6dd2fcaab7a"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.349\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/cd48a37b-e66f-4ebd-8faf-794da940c5c2"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.351\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/a74918df-6044-4ba8-bcc6-5cbb06d192cf"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.393\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/7b6870c6-8030-49c9-94c1-f425d13d0b59"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.395\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/c6cc0f5f-26ab-420f-8211-7315acdd0087"
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/af94e717-488c-4049-aa6e-6fed1953f3e2",
"resource": {
"resourceType": "Bundle",
"id": "af94e717-488c-4049-aa6e-6fed1953f3e2",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.276\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/9c930acd-0757-4f1c-975e-951293a4674b",
"resource": {
"resourceType": "MessageHeader",
"id": "9c930acd-0757-4f1c-975e-951293a4674b",
"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": "60714d96-7ea5-4e93-b62e-be2926047368",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/d07a4b18-3fdf-404b-aa5e-16a42d81232b"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/d07a4b18-3fdf-404b-aa5e-16a42d81232b",
"resource": {
"resourceType": "ClaimResponse",
"id": "d07a4b18-3fdf-404b-aa5e-16a42d81232b",
"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": "2267"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "d07a4b18-3fdf-404b-aa5e-16a42d81232b"
}
],
"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/bcb3afcd-851b-4b89-a87e-d1af9c1b1242"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/c5bc1a83-db81-41d2-bf3d-b5f4709cd980"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/8c5c31f0-eecc-4b4f-9ce3-eae0a8ac3668"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "99282290260926"
}
},
"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": "99366"
}
}
],
"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": 4.54,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 4.54,
"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": 4.54,
"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": "99366"
}
}
],
"itemSequence": 2,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 45.58,
"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": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "CV-4-5"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 45.58,
"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": "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": "99366"
}
}
],
"itemSequence": 3,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 6.48,
"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": 6.48,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 6.48,
"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://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": "99366"
}
}
],
"itemSequence": 4,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 11.07,
"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": 11.07,
"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": 11.07,
"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": "99366"
}
}
],
"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": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 30.94,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 5.53,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 30.94,
"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://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": "99366"
}
}
],
"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": 17.43,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 3.11,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 17.43,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 12.46,
"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
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 116.04,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 34.55,
"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": 8.64,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 116.04,
"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/611ffdd7-f161-4756-9882-a85cbdff7b18"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/bcb3afcd-851b-4b89-a87e-d1af9c1b1242",
"resource": {
"resourceType": "Patient",
"id": "bcb3afcd-851b-4b89-a87e-d1af9c1b1242",
"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": "2292569130"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "edyy amin numan alaqab",
"given": [
"edyy",
"numan",
"alaqab"
]
}
],
"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": "1983-06-20",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/8c5c31f0-eecc-4b4f-9ce3-eae0a8ac3668",
"resource": {
"resourceType": "Organization",
"id": "8c5c31f0-eecc-4b4f-9ce3-eae0a8ac3668",
"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/c5bc1a83-db81-41d2-bf3d-b5f4709cd980",
"resource": {
"resourceType": "Organization",
"id": "c5bc1a83-db81-41d2-bf3d-b5f4709cd980",
"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/611ffdd7-f161-4756-9882-a85cbdff7b18",
"resource": {
"resourceType": "Coverage",
"id": "611ffdd7-f161-4756-9882-a85cbdff7b18",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002292569130001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/9981e70f-a215-41a3-835c-be5aeccd49cb"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/38b81152-9a36-4df7-8b5f-91b9df8f8468"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/bcb3afcd-851b-4b89-a87e-d1af9c1b1242"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/c5bc1a83-db81-41d2-bf3d-b5f4709cd980"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "55987708",
"name": "Tadamun Alawal Company"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/9981e70f-a215-41a3-835c-be5aeccd49cb",
"resource": {
"resourceType": "Organization",
"id": "9981e70f-a215-41a3-835c-be5aeccd49cb",
"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/38b81152-9a36-4df7-8b5f-91b9df8f8468",
"resource": {
"resourceType": "Patient",
"id": "38b81152-9a36-4df7-8b5f-91b9df8f8468",
"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": "2292569130"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "edyy amin numan alaqab",
"given": [
"edyy",
"numan",
"alaqab"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0506138057"
}
],
"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": "1983-06-20",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/eb07b1d8-a7d4-4064-8152-ba975e2e3be3",
"resource": {
"resourceType": "Bundle",
"id": "eb07b1d8-a7d4-4064-8152-ba975e2e3be3",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.776\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/33bc6dd2-3725-466e-8d65-2debf1bf8068",
"resource": {
"resourceType": "MessageHeader",
"id": "33bc6dd2-3725-466e-8d65-2debf1bf8068",
"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": "a786e97f-d462-4045-a6fc-6ff5b5db99c9",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/267a8dc3-05dc-409b-ac20-05687b71e1e3"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/267a8dc3-05dc-409b-ac20-05687b71e1e3",
"resource": {
"resourceType": "ClaimResponse",
"id": "267a8dc3-05dc-409b-ac20-05687b71e1e3",
"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": "1264"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "267a8dc3-05dc-409b-ac20-05687b71e1e3"
}
],
"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/f004c0d6-58db-4269-8502-75a8a82520bf"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/62d96a1e-8315-431e-974e-29f9e9a7beec"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/1e1efc5a-0328-4a24-8cc1-1dfc6b20fa8b"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "88254737260915"
}
},
"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": "88679"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 7.7,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 9.63,
"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": 9.63,
"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": 1.93,
"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": "88679"
}
}
],
"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": 4.03,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.01,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 5.04,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 5.04,
"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": 14.67,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 11.73,
"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": 2.94,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 14.67,
"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/560be410-0873-4ee2-ab6c-dc139acf6178"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/f004c0d6-58db-4269-8502-75a8a82520bf",
"resource": {
"resourceType": "Patient",
"id": "f004c0d6-58db-4269-8502-75a8a82520bf",
"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": "1094916119"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "NAYEF ALI MAEED ALZAHRANI",
"given": [
"NAYEF",
"MAEED",
"ALZAHRANI"
]
}
],
"gender": "male",
"_gender": {
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code": "male",
"display": "male"
}
]
}
}
]
},
"birthDate": "1996-02-06",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/1e1efc5a-0328-4a24-8cc1-1dfc6b20fa8b",
"resource": {
"resourceType": "Organization",
"id": "1e1efc5a-0328-4a24-8cc1-1dfc6b20fa8b",
"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/62d96a1e-8315-431e-974e-29f9e9a7beec",
"resource": {
"resourceType": "Organization",
"id": "62d96a1e-8315-431e-974e-29f9e9a7beec",
"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/560be410-0873-4ee2-ab6c-dc139acf6178",
"resource": {
"resourceType": "Coverage",
"id": "560be410-0873-4ee2-ab6c-dc139acf6178",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "001094916119001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/ac4d7404-0a3d-479a-b773-d55db690f448"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/8aaae63a-47fe-4ba2-8ae3-d60fca354c05"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/f004c0d6-58db-4269-8502-75a8a82520bf"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/62d96a1e-8315-431e-974e-29f9e9a7beec"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "52419489",
"name": "BUNYAN JAWAR ALARABIA COMPANY FOR"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/ac4d7404-0a3d-479a-b773-d55db690f448",
"resource": {
"resourceType": "Organization",
"id": "ac4d7404-0a3d-479a-b773-d55db690f448",
"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/8aaae63a-47fe-4ba2-8ae3-d60fca354c05",
"resource": {
"resourceType": "Patient",
"id": "8aaae63a-47fe-4ba2-8ae3-d60fca354c05",
"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": "1094916119"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "NAYEF ALI MAEED ALZAHRANI",
"given": [
"NAYEF",
"MAEED",
"ALZAHRANI"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0550996794"
}
],
"gender": "male",
"_gender": {
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code": "male",
"display": "male"
}
]
}
}
]
},
"birthDate": "1996-02-06",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/117cd5e7-2608-464f-a259-efec684311aa",
"resource": {
"resourceType": "Bundle",
"id": "117cd5e7-2608-464f-a259-efec684311aa",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.739\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/ef98733b-e7ab-4559-9b5a-96107911a186",
"resource": {
"resourceType": "MessageHeader",
"id": "ef98733b-e7ab-4559-9b5a-96107911a186",
"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": "da77653d-1e62-48e9-9dfa-e6e4d1c2c05e",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/fc1a6b20-e2b2-4b1b-b5cc-72f8706548c0"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/fc1a6b20-e2b2-4b1b-b5cc-72f8706548c0",
"resource": {
"resourceType": "ClaimResponse",
"id": "fc1a6b20-e2b2-4b1b-b5cc-72f8706548c0",
"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": "1239"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "fc1a6b20-e2b2-4b1b-b5cc-72f8706548c0"
}
],
"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/0c1e64a4-b8ad-4823-bd6c-2b1e3fdab546"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/f97add43-80f4-455e-acbb-60b28b62178d"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/c8baf23a-3138-4a7e-a273-2549154cb430"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "79254154260915"
}
},
"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": "88486"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 32.11,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 40.14,
"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": 40.14,
"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://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": "88486"
}
}
],
"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": 10.69,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 2.67,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 13.36,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 13.36,
"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": 53.5,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 42.8,
"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": 10.7,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 53.5,
"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/827c80f2-f96a-402c-a259-01a5de43a9c4"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/0c1e64a4-b8ad-4823-bd6c-2b1e3fdab546",
"resource": {
"resourceType": "Patient",
"id": "0c1e64a4-b8ad-4823-bd6c-2b1e3fdab546",
"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": "2545170082"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "haitham abdelkhalek ABRAHEM MORAD",
"given": [
"haitham",
"ABRAHEM",
"MORAD"
]
}
],
"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": "1983-01-01",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/c8baf23a-3138-4a7e-a273-2549154cb430",
"resource": {
"resourceType": "Organization",
"id": "c8baf23a-3138-4a7e-a273-2549154cb430",
"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/f97add43-80f4-455e-acbb-60b28b62178d",
"resource": {
"resourceType": "Organization",
"id": "f97add43-80f4-455e-acbb-60b28b62178d",
"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/827c80f2-f96a-402c-a259-01a5de43a9c4",
"resource": {
"resourceType": "Coverage",
"id": "827c80f2-f96a-402c-a259-01a5de43a9c4",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002545170082001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/3a6d076a-863f-4065-9b4e-51855bf5c2a2"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/d36ee14a-20cc-4005-bb63-5305f1e350e9"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/0c1e64a4-b8ad-4823-bd6c-2b1e3fdab546"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/f97add43-80f4-455e-acbb-60b28b62178d"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "55710460",
"name": "ALMASAR ALMUBASHER CO"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/3a6d076a-863f-4065-9b4e-51855bf5c2a2",
"resource": {
"resourceType": "Organization",
"id": "3a6d076a-863f-4065-9b4e-51855bf5c2a2",
"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/d36ee14a-20cc-4005-bb63-5305f1e350e9",
"resource": {
"resourceType": "Patient",
"id": "d36ee14a-20cc-4005-bb63-5305f1e350e9",
"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": "2545170082"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "haitham abdelkhalek ABRAHEM MORAD",
"given": [
"haitham",
"ABRAHEM",
"MORAD"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0537367834"
}
],
"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": "1983-01-01",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/06cf103f-e188-406e-a9da-c129adfc725d",
"resource": {
"resourceType": "Bundle",
"id": "06cf103f-e188-406e-a9da-c129adfc725d",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.699\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/5583f770-7665-48a1-9d23-44d04de91857",
"resource": {
"resourceType": "MessageHeader",
"id": "5583f770-7665-48a1-9d23-44d04de91857",
"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": "a62b29d4-bb12-4286-89a4-af1be3231245",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/a781bfea-9c6d-4ea3-b8c6-d967221b631e"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/a781bfea-9c6d-4ea3-b8c6-d967221b631e",
"resource": {
"resourceType": "ClaimResponse",
"id": "a781bfea-9c6d-4ea3-b8c6-d967221b631e",
"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": "2265"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "a781bfea-9c6d-4ea3-b8c6-d967221b631e"
}
],
"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/ae165e9e-a127-43a7-ba6a-3bf5e2d38875"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/b8b7ff2b-bdd5-4a85-8019-aa9b2c76a844"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/6924efef-b59c-4d8a-bde8-a2e7f741249b"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "77282258260926"
}
},
"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": "99347"
}
}
],
"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": 11.11,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 8.89,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 2.22,
"currency": "SAR"
}
},
{
"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://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": "99347"
}
}
],
"itemSequence": 2,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 6.35,
"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": "benefit"
}
]
},
"amount": {
"value": 4.54,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 6.35,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.13,
"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": "99347"
}
}
],
"itemSequence": 3,
"adjudication": [
{
"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": "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": "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": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 8.15,
"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": "99347"
}
}
],
"itemSequence": 4,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 12.01,
"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": 12.01,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 2.4,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 9.61,
"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": "approved"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "99347"
}
}
],
"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": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 32.67,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 6.53,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 32.67,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 26.14,
"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": "99347"
}
}
],
"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": 5.13,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.03,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 5.13,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 4.1,
"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
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 108.04,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 53.28,
"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": 21.46,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 108.04,
"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/e0276a0a-ae4d-45ed-8745-0b5ccfdcb99a"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/ae165e9e-a127-43a7-ba6a-3bf5e2d38875",
"resource": {
"resourceType": "Patient",
"id": "ae165e9e-a127-43a7-ba6a-3bf5e2d38875",
"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": "1206960781"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "HETAN IMAD ABDULKAREEM ALLAHIBI",
"given": [
"HETAN",
"ABDULKAREEM",
"ALLAHIBI"
]
}
],
"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": "2022-08-07",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/6924efef-b59c-4d8a-bde8-a2e7f741249b",
"resource": {
"resourceType": "Organization",
"id": "6924efef-b59c-4d8a-bde8-a2e7f741249b",
"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/b8b7ff2b-bdd5-4a85-8019-aa9b2c76a844",
"resource": {
"resourceType": "Organization",
"id": "b8b7ff2b-bdd5-4a85-8019-aa9b2c76a844",
"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/e0276a0a-ae4d-45ed-8745-0b5ccfdcb99a",
"resource": {
"resourceType": "Coverage",
"id": "e0276a0a-ae4d-45ed-8745-0b5ccfdcb99a",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "001095906960201"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/b69c7b4b-632c-44d6-8635-9fe9c56ce4e4"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/d3bd3551-1dfa-4a38-9979-4fff511aeb03"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/ae165e9e-a127-43a7-ba6a-3bf5e2d38875"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/b8b7ff2b-bdd5-4a85-8019-aa9b2c76a844"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "55287460",
"name": "SHAHIA FOOD LIMITED COMPANY"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/b69c7b4b-632c-44d6-8635-9fe9c56ce4e4",
"resource": {
"resourceType": "Organization",
"id": "b69c7b4b-632c-44d6-8635-9fe9c56ce4e4",
"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/d3bd3551-1dfa-4a38-9979-4fff511aeb03",
"resource": {
"resourceType": "Patient",
"id": "d3bd3551-1dfa-4a38-9979-4fff511aeb03",
"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": "1206960781"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "HETAN IMAD ABDULKAREEM ALLAHIBI",
"given": [
"HETAN",
"ABDULKAREEM",
"ALLAHIBI"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0543154226"
}
],
"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": "2022-08-07",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/40975dc9-f4fd-48be-b900-e18267269528",
"resource": {
"resourceType": "Bundle",
"id": "40975dc9-f4fd-48be-b900-e18267269528",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.509\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/31b2fec0-987c-4be7-9055-778283712e7c",
"resource": {
"resourceType": "MessageHeader",
"id": "31b2fec0-987c-4be7-9055-778283712e7c",
"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": "7fb088ec-9813-49de-9eb2-1eb645ef1bcb",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/a8a42fa4-e184-4738-90ae-e3f535dca6b5"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/a8a42fa4-e184-4738-90ae-e3f535dca6b5",
"resource": {
"resourceType": "ClaimResponse",
"id": "a8a42fa4-e184-4738-90ae-e3f535dca6b5",
"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": "2206"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "a8a42fa4-e184-4738-90ae-e3f535dca6b5"
}
],
"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/1ea2fbff-84df-419b-92a2-7fd47e9a08d1"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/745cfdb4-90c3-40f1-9744-06e25ac99216"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/62c68d00-67d6-465c-a1bd-ae5a34fcae98"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "8280497260926"
}
},
"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": "98761"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 6.35,
"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": 6.35,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 4.54,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.13,
"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": "98761"
}
}
],
"itemSequence": 2,
"adjudication": [
{
"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": "tax"
}
]
},
"amount": {
"value": 0,
"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://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 30.6,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 24.48,
"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": "98761"
}
}
],
"itemSequence": 3,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 7.42,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 7.42,
"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": 1.48,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 4.95,
"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": "98761"
}
}
],
"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": 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": "MN-1-1"
}
]
},
"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://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": "98761"
}
}
],
"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": 8.37,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.67,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 8.37,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 6.7,
"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
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 93.51,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 40.67,
"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": 18.55,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 93.51,
"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/ea8a8869-dbd4-4323-9241-88843f8d4c13"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/1ea2fbff-84df-419b-92a2-7fd47e9a08d1",
"resource": {
"resourceType": "Patient",
"id": "1ea2fbff-84df-419b-92a2-7fd47e9a08d1",
"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": "2527103853"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "ahmed muhammad AIYUB",
"given": [
"ahmed",
"muhammad",
"AIYUB"
]
}
],
"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": "2012-10-12",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/62c68d00-67d6-465c-a1bd-ae5a34fcae98",
"resource": {
"resourceType": "Organization",
"id": "62c68d00-67d6-465c-a1bd-ae5a34fcae98",
"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/745cfdb4-90c3-40f1-9744-06e25ac99216",
"resource": {
"resourceType": "Organization",
"id": "745cfdb4-90c3-40f1-9744-06e25ac99216",
"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/ea8a8869-dbd4-4323-9241-88843f8d4c13",
"resource": {
"resourceType": "Coverage",
"id": "ea8a8869-dbd4-4323-9241-88843f8d4c13",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002042847141221"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/02280bbb-874b-432c-aac9-3ecd2271bf2e"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/15d12508-af73-4c8b-9f51-e1a08aa46ce6"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/1ea2fbff-84df-419b-92a2-7fd47e9a08d1"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/745cfdb4-90c3-40f1-9744-06e25ac99216"
}
],
"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/02280bbb-874b-432c-aac9-3ecd2271bf2e",
"resource": {
"resourceType": "Organization",
"id": "02280bbb-874b-432c-aac9-3ecd2271bf2e",
"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/15d12508-af73-4c8b-9f51-e1a08aa46ce6",
"resource": {
"resourceType": "Patient",
"id": "15d12508-af73-4c8b-9f51-e1a08aa46ce6",
"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": "2527103853"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "ahmed muhammad AIYUB",
"given": [
"ahmed",
"muhammad",
"AIYUB"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0591199901"
}
],
"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": "2012-10-12",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/42ea93fb-e8a9-4c89-984a-f6dd2fcaab7a",
"resource": {
"resourceType": "Bundle",
"id": "42ea93fb-e8a9-4c89-984a-f6dd2fcaab7a",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.699\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/7cc595c4-1376-4b9e-9a94-37a8539b13f9",
"resource": {
"resourceType": "MessageHeader",
"id": "7cc595c4-1376-4b9e-9a94-37a8539b13f9",
"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": "409324ae-5603-4c15-a0c5-d24ca7518531",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/c05e4697-6384-4b37-b07a-c7f0958aee46"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/c05e4697-6384-4b37-b07a-c7f0958aee46",
"resource": {
"resourceType": "ClaimResponse",
"id": "c05e4697-6384-4b37-b07a-c7f0958aee46",
"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": "2363"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "c05e4697-6384-4b37-b07a-c7f0958aee46"
}
],
"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/3c137bed-8e28-45f7-8f47-329598c4e067"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/0afb9dc8-53b0-404b-a08c-a3920a5daf8e"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/12cde3d4-e262-4b01-9dc3-c7be938b129e"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "52284917260927"
}
},
"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": "100230"
}
}
],
"itemSequence": 1,
"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": "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://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://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": "100230"
}
}
],
"itemSequence": 2,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 38.88,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 38.88,
"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": "benefit"
}
]
},
"amount": {
"value": 31.1,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 7.78,
"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": "100230"
}
}
],
"itemSequence": 3,
"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": 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://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": "100230"
}
}
],
"itemSequence": 4,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 16.88,
"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": 4.22,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 21.1,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 21.1,
"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
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 100.25,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 80.2,
"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": 20.05,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 100.25,
"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/a56e985c-6d87-46b2-b6c6-67cfbc72d7cb"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/3c137bed-8e28-45f7-8f47-329598c4e067",
"resource": {
"resourceType": "Patient",
"id": "3c137bed-8e28-45f7-8f47-329598c4e067",
"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": "2357694302"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "OTHMAN ABRAHEM ashour",
"given": [
"OTHMAN",
"ABRAHEM",
"ashour"
]
}
],
"gender": "male",
"_gender": {
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code": "male",
"display": "male"
}
]
}
}
]
},
"birthDate": "1987-01-01",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/12cde3d4-e262-4b01-9dc3-c7be938b129e",
"resource": {
"resourceType": "Organization",
"id": "12cde3d4-e262-4b01-9dc3-c7be938b129e",
"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/0afb9dc8-53b0-404b-a08c-a3920a5daf8e",
"resource": {
"resourceType": "Organization",
"id": "0afb9dc8-53b0-404b-a08c-a3920a5daf8e",
"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/a56e985c-6d87-46b2-b6c6-67cfbc72d7cb",
"resource": {
"resourceType": "Coverage",
"id": "a56e985c-6d87-46b2-b6c6-67cfbc72d7cb",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002357694302001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/26412ebf-4183-4996-94e3-e0bd004acac7"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/4d6a2662-9235-43dd-9edb-e7a1237b379c"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/3c137bed-8e28-45f7-8f47-329598c4e067"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/0afb9dc8-53b0-404b-a08c-a3920a5daf8e"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "52933074",
"name": "Abdul Muttalib Compa Basic B"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/26412ebf-4183-4996-94e3-e0bd004acac7",
"resource": {
"resourceType": "Organization",
"id": "26412ebf-4183-4996-94e3-e0bd004acac7",
"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/4d6a2662-9235-43dd-9edb-e7a1237b379c",
"resource": {
"resourceType": "Patient",
"id": "4d6a2662-9235-43dd-9edb-e7a1237b379c",
"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": "2357694302"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "OTHMAN ABRAHEM ashour",
"given": [
"OTHMAN",
"ABRAHEM",
"ashour"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0562316335"
}
],
"gender": "male",
"_gender": {
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code": "male",
"display": "male"
}
]
}
}
]
},
"birthDate": "1987-01-01",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/cd48a37b-e66f-4ebd-8faf-794da940c5c2",
"resource": {
"resourceType": "Bundle",
"id": "cd48a37b-e66f-4ebd-8faf-794da940c5c2",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.540\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/b27a5964-baf4-4da8-a9f5-5b6c5f238e6f",
"resource": {
"resourceType": "MessageHeader",
"id": "b27a5964-baf4-4da8-a9f5-5b6c5f238e6f",
"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": "e9bbea7d-06a3-4721-9efe-d513ba049b3d",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/33b1d69b-93c5-4dfa-9feb-d7d511aec160"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/33b1d69b-93c5-4dfa-9feb-d7d511aec160",
"resource": {
"resourceType": "ClaimResponse",
"id": "33b1d69b-93c5-4dfa-9feb-d7d511aec160",
"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": "1685"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "33b1d69b-93c5-4dfa-9feb-d7d511aec160"
}
],
"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/50bfefe0-ca81-489b-95cd-175d80e7fa42"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/37cae738-5d82-48d1-a24a-8716a8ca915f"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/7101bf6c-cf78-4923-a407-a161de7b2886"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "67266671260920"
}
},
"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": "93316"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 10.21,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 2.04,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 8.17,
"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": 10.21,
"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": 10.21,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 8.17,
"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": 2.04,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 10.21,
"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/5ebee12d-f47b-4138-89c7-2e958216201b"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/50bfefe0-ca81-489b-95cd-175d80e7fa42",
"resource": {
"resourceType": "Patient",
"id": "50bfefe0-ca81-489b-95cd-175d80e7fa42",
"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": "2129319337"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "TASNIM yousuf \u0642\u0637\u0645\u0627\u0648\u064A",
"given": [
"TASNIM",
"yousuf",
"\u0642\u0637\u0645\u0627\u0648\u064A"
]
}
],
"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": "1997-06-19",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/7101bf6c-cf78-4923-a407-a161de7b2886",
"resource": {
"resourceType": "Organization",
"id": "7101bf6c-cf78-4923-a407-a161de7b2886",
"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/37cae738-5d82-48d1-a24a-8716a8ca915f",
"resource": {
"resourceType": "Organization",
"id": "37cae738-5d82-48d1-a24a-8716a8ca915f",
"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/5ebee12d-f47b-4138-89c7-2e958216201b",
"resource": {
"resourceType": "Coverage",
"id": "5ebee12d-f47b-4138-89c7-2e958216201b",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002090177524101"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/c2e9c413-7d57-4dac-a1c3-456643bc18a2"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/50eed2fb-9c74-45a8-b957-6ef4a1926431"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/50bfefe0-ca81-489b-95cd-175d80e7fa42"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/37cae738-5d82-48d1-a24a-8716a8ca915f"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "54373369",
"name": "Al Tawfiq Al Mumayaz Basic"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/c2e9c413-7d57-4dac-a1c3-456643bc18a2",
"resource": {
"resourceType": "Organization",
"id": "c2e9c413-7d57-4dac-a1c3-456643bc18a2",
"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/50eed2fb-9c74-45a8-b957-6ef4a1926431",
"resource": {
"resourceType": "Patient",
"id": "50eed2fb-9c74-45a8-b957-6ef4a1926431",
"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": "2129319337"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "TASNIM yousuf \u0642\u0637\u0645\u0627\u0648\u064A",
"given": [
"TASNIM",
"yousuf",
"\u0642\u0637\u0645\u0627\u0648\u064A"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0530412429"
}
],
"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": "1997-06-19",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/a74918df-6044-4ba8-bcc6-5cbb06d192cf",
"resource": {
"resourceType": "Bundle",
"id": "a74918df-6044-4ba8-bcc6-5cbb06d192cf",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.277\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/3b13da6c-35a4-4aab-abe6-09fe751ab349",
"resource": {
"resourceType": "MessageHeader",
"id": "3b13da6c-35a4-4aab-abe6-09fe751ab349",
"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": "2db7f911-e208-43f8-8d58-895067a819c7",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/05d649a5-b05e-4751-89a2-b91a2b57245e"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/05d649a5-b05e-4751-89a2-b91a2b57245e",
"resource": {
"resourceType": "ClaimResponse",
"id": "05d649a5-b05e-4751-89a2-b91a2b57245e",
"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": "2515"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "05d649a5-b05e-4751-89a2-b91a2b57245e"
}
],
"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/52059e4f-7338-4364-88d6-62fd9df119f4"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/423502c6-74ed-476a-a441-1e885ab2191a"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/20b04e74-a15a-4e24-b194-6259e9b79b71"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "92290138260929"
}
},
"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": "102018"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 4.63,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 0.93,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 3.7,
"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": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 4.63,
"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": 4.63,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 3.7,
"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": 0.93,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 4.63,
"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/ea960782-ca01-47bb-8cc0-71f359ecdae5"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/52059e4f-7338-4364-88d6-62fd9df119f4",
"resource": {
"resourceType": "Patient",
"id": "52059e4f-7338-4364-88d6-62fd9df119f4",
"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": "1175781507"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "GHALIAH faris ALHARBI",
"given": [
"GHALIAH",
"faris",
"ALHARBI"
]
}
],
"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": "2015-11-02",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/20b04e74-a15a-4e24-b194-6259e9b79b71",
"resource": {
"resourceType": "Organization",
"id": "20b04e74-a15a-4e24-b194-6259e9b79b71",
"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/423502c6-74ed-476a-a441-1e885ab2191a",
"resource": {
"resourceType": "Organization",
"id": "423502c6-74ed-476a-a441-1e885ab2191a",
"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/ea960782-ca01-47bb-8cc0-71f359ecdae5",
"resource": {
"resourceType": "Coverage",
"id": "ea960782-ca01-47bb-8cc0-71f359ecdae5",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "001025869676751"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/89d1e8b2-a973-4ffb-963f-8c5deae6d171"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/2cc72eac-5272-4b83-a2bc-9705b45ac40e"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/52059e4f-7338-4364-88d6-62fd9df119f4"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/423502c6-74ed-476a-a441-1e885ab2191a"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "56466034",
"name": "Dar Al Taqwa Company Basic B"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/89d1e8b2-a973-4ffb-963f-8c5deae6d171",
"resource": {
"resourceType": "Organization",
"id": "89d1e8b2-a973-4ffb-963f-8c5deae6d171",
"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/2cc72eac-5272-4b83-a2bc-9705b45ac40e",
"resource": {
"resourceType": "Patient",
"id": "2cc72eac-5272-4b83-a2bc-9705b45ac40e",
"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": "1175781507"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "GHALIAH faris ALHARBI",
"given": [
"GHALIAH",
"faris",
"ALHARBI"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0556727195"
}
],
"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": "2015-11-02",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/7b6870c6-8030-49c9-94c1-f425d13d0b59",
"resource": {
"resourceType": "Bundle",
"id": "7b6870c6-8030-49c9-94c1-f425d13d0b59",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.411\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/e5e84a9a-e506-40ec-b57c-9adb53b464df",
"resource": {
"resourceType": "MessageHeader",
"id": "e5e84a9a-e506-40ec-b57c-9adb53b464df",
"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": "61808063-6d45-44f3-b33a-db926dbd2e6b",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/6386f376-6772-4230-9093-bde6aba64e53"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/6386f376-6772-4230-9093-bde6aba64e53",
"resource": {
"resourceType": "ClaimResponse",
"id": "6386f376-6772-4230-9093-bde6aba64e53",
"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": "1825"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "6386f376-6772-4230-9093-bde6aba64e53"
}
],
"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/afc3e37a-da31-47eb-a98c-a84b754f4a45"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/492485e3-ebe9-4200-9f81-ecf4430c170d"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/2ccb7698-0558-41dc-ad52-187a4b018e8b"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "53270215260921"
}
},
"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": "94581"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 26.14,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 32.67,
"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": "copay"
}
]
},
"amount": {
"value": 6.53,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 32.67,
"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": "94581"
}
}
],
"itemSequence": 2,
"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": 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": "submitted"
}
]
},
"amount": {
"value": 11.11,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 2.22,
"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://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": "94581"
}
}
],
"itemSequence": 3,
"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": "tax"
}
]
},
"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": 7.42,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 7.42,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "CV-4-5"
}
]
},
"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": "94581"
}
}
],
"itemSequence": 4,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 12.01,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 9.61,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 2.4,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 12.01,
"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": "94581"
}
}
],
"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": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 4.54,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 6.35,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.13,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 6.35,
"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": "94581"
}
}
],
"itemSequence": 6,
"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": "eligible"
}
]
},
"amount": {
"value": 8.37,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.67,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 8.37,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "CV-4-5"
}
]
},
"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": "rejected"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "94581"
}
}
],
"itemSequence": 7,
"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": 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": "MN-1-1"
}
]
},
"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://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": 118.7,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 40.29,
"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": 23.58,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 118.7,
"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/4c1bbc0b-f72e-45b6-8902-94a8627a4114"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/afc3e37a-da31-47eb-a98c-a84b754f4a45",
"resource": {
"resourceType": "Patient",
"id": "afc3e37a-da31-47eb-a98c-a84b754f4a45",
"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": "2589279518"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "RAYAN KALID MOSTAFA ALDALI",
"given": [
"RAYAN",
"MOSTAFA",
"ALDALI"
]
}
],
"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": "2024-11-11",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/2ccb7698-0558-41dc-ad52-187a4b018e8b",
"resource": {
"resourceType": "Organization",
"id": "2ccb7698-0558-41dc-ad52-187a4b018e8b",
"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/492485e3-ebe9-4200-9f81-ecf4430c170d",
"resource": {
"resourceType": "Organization",
"id": "492485e3-ebe9-4200-9f81-ecf4430c170d",
"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/4c1bbc0b-f72e-45b6-8902-94a8627a4114",
"resource": {
"resourceType": "Coverage",
"id": "4c1bbc0b-f72e-45b6-8902-94a8627a4114",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002264531803221"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/4c207344-8236-418a-9684-488a8f8afffd"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/983d5a87-a282-4f12-92f6-761cb1b50dc8"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/afc3e37a-da31-47eb-a98c-a84b754f4a45"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/492485e3-ebe9-4200-9f81-ecf4430c170d"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "55016630",
"name": "united electronics campany"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/4c207344-8236-418a-9684-488a8f8afffd",
"resource": {
"resourceType": "Organization",
"id": "4c207344-8236-418a-9684-488a8f8afffd",
"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/983d5a87-a282-4f12-92f6-761cb1b50dc8",
"resource": {
"resourceType": "Patient",
"id": "983d5a87-a282-4f12-92f6-761cb1b50dc8",
"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": "2589279518"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "RAYAN KALID MOSTAFA ALDALI",
"given": [
"RAYAN",
"MOSTAFA",
"ALDALI"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0569100222"
}
],
"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": "2024-11-11",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/c6cc0f5f-26ab-420f-8211-7315acdd0087",
"resource": {
"resourceType": "Bundle",
"id": "c6cc0f5f-26ab-420f-8211-7315acdd0087",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.920\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/f0f42010-28c9-4603-b56d-0c4dc9ad2fc8",
"resource": {
"resourceType": "MessageHeader",
"id": "f0f42010-28c9-4603-b56d-0c4dc9ad2fc8",
"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": "8b2cebb0-9dd5-4fe7-beca-cfba123cabb6",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/5bb34e4d-91bc-49d0-8389-7f6c66cb7d3d"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/5bb34e4d-91bc-49d0-8389-7f6c66cb7d3d",
"resource": {
"resourceType": "ClaimResponse",
"id": "5bb34e4d-91bc-49d0-8389-7f6c66cb7d3d",
"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": "2292"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "5bb34e4d-91bc-49d0-8389-7f6c66cb7d3d"
}
],
"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/4511f816-8ff2-4559-867e-456794cdb0dc"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/66a48a6c-641b-4b8d-b2f7-838285067a9a"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/88a072ac-bbfa-4a37-aa37-6dda163d50e7"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "28282833260927"
}
},
"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": "99558"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 32.11,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 40.14,
"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": 40.14,
"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://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": "99558"
}
}
],
"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": 10.69,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 2.67,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 13.36,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 13.36,
"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": 53.5,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 42.8,
"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": 10.7,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 53.5,
"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/7c20e58a-7f97-44ad-bb47-be6a2f18e028"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/4511f816-8ff2-4559-867e-456794cdb0dc",
"resource": {
"resourceType": "Patient",
"id": "4511f816-8ff2-4559-867e-456794cdb0dc",
"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": "2500192758"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "nasir saleh alhdad",
"given": [
"nasir",
"saleh",
"alhdad"
]
}
],
"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": "1976-01-01",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/88a072ac-bbfa-4a37-aa37-6dda163d50e7",
"resource": {
"resourceType": "Organization",
"id": "88a072ac-bbfa-4a37-aa37-6dda163d50e7",
"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/66a48a6c-641b-4b8d-b2f7-838285067a9a",
"resource": {
"resourceType": "Organization",
"id": "66a48a6c-641b-4b8d-b2f7-838285067a9a",
"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/7c20e58a-7f97-44ad-bb47-be6a2f18e028",
"resource": {
"resourceType": "Coverage",
"id": "7c20e58a-7f97-44ad-bb47-be6a2f18e028",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002500192758001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/c1089a16-f220-4423-a82e-5cd1f870a873"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/1dd2633f-d6c4-4ac8-b55e-106ee93ad4d7"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/4511f816-8ff2-4559-867e-456794cdb0dc"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/66a48a6c-641b-4b8d-b2f7-838285067a9a"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "55592123",
"name": "Al Adeeb Logistics S Basic B"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/c1089a16-f220-4423-a82e-5cd1f870a873",
"resource": {
"resourceType": "Organization",
"id": "c1089a16-f220-4423-a82e-5cd1f870a873",
"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/1dd2633f-d6c4-4ac8-b55e-106ee93ad4d7",
"resource": {
"resourceType": "Patient",
"id": "1dd2633f-d6c4-4ac8-b55e-106ee93ad4d7",
"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": "2500192758"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "nasir saleh alhdad",
"given": [
"nasir",
"saleh",
"alhdad"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0560380432"
}
],
"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": "1976-01-01",
"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"
}
}
]
}
No stored-procedure executions recorded
Either the poll failed before reaching the database, or SQL capture
is switched off in the Diagnostics configuration section.