Error Al-Kholood Medical Company - AlHaj claim-response
All traces- Trace
- 77032c67-8f36-457a-b2f2-79bf277195b1
- Started
- 2026-10-31 13:07:25.488 +03:00
- Branch
- Al-Kholood Medical Company - AlHaj (9)
- Mode
- Middleware
- Service URL
- https://nphies.careofme.net/api/v1/nphies/send
- HTTP
- 200 in 7805 ms
- Bundle / Request
- 1bcb4e61-9450-49c5-a9dc-281153dab8a0 / 699619
- Parsed items
- 0
- Total duration
- 27848 ms
- Error
- Cannot open database "NitcoSysLog" requested by the login. The login failed. Login failed for user 'NitcoWebcenter'.
{
"resourceType": "Bundle",
"id": "1bcb4e61-9450-49c5-a9dc-281153dab8a0",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-31T13:07:25.48\u002B03:00",
"entry": [
{
"fullUrl": "urn:uuid:4c3afa54-82e5-451f-8a0a-deaa9cb8a695",
"resource": {
"resourceType": "MessageHeader",
"id": "4c3afa54-82e5-451f-8a0a-deaa9cb8a695",
"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/699619"
}
]
}
},
{
"fullUrl": "http://www.ALKholood.com/Task/699619",
"resource": {
"resourceType": "Task",
"id": "699619",
"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_920261031130725"
}
],
"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": "1bcb4e61-9450-49c5-a9dc-281153dab8a0"
}
{
"resourceType": "Bundle",
"id": "63dfa3c9-796c-4ae4-8158-21258e379a73",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-31T13:07:32.931\u002B03:00",
"entry": [
{
"fullUrl": "http://nphies.sa/MessageHeader/7056e137-4893-43ba-bef1-93a76af8e7a2",
"resource": {
"resourceType": "MessageHeader",
"id": "7056e137-4893-43ba-bef1-93a76af8e7a2",
"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": "4c3afa54-82e5-451f-8a0a-deaa9cb8a695",
"code": "ok"
}
}
},
{
"fullUrl": "http://nphies.sa/Task/ab9d2896-418b-4313-aa30-1cebf1e6141f",
"resource": {
"resourceType": "Task",
"id": "ab9d2896-418b-4313-aa30-1cebf1e6141f",
"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": "323"
}
],
"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": "2026-10-20T08:55:11.899\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/32534508-56ba-4ca9-938a-d29345807c54"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:11.909\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/eabce18b-99a3-4681-b42a-00a88ce1cb50"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:11.934\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/d592211c-9ee4-4d24-97b5-6a014a7ea49f"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:11.990\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/c94396eb-f13c-4480-9615-4aadf6261f56"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.023\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/95ed4f22-aee5-4c25-a229-39a93ef3f492"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.089\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/330448eb-146e-4195-95fd-f7aebddcbf9e"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.109\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/86354706-9e62-453f-97e8-f77014ed514d"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.121\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/d6ffc1ff-7140-4e6e-ac73-07efb8a33928"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.126\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/12d34790-915f-422c-90c6-010d11bf3d5b"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:55:12.155\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/f5ec51b9-c5ef-4c5c-af0f-547fbcb068e5"
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/32534508-56ba-4ca9-938a-d29345807c54",
"resource": {
"resourceType": "Bundle",
"id": "32534508-56ba-4ca9-938a-d29345807c54",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.448\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/2b02f8f4-b792-4388-99a8-edc295ea368e",
"resource": {
"resourceType": "MessageHeader",
"id": "2b02f8f4-b792-4388-99a8-edc295ea368e",
"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": "4bf65b45-7c44-4ae0-a74e-ad8bff1b2d10",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/28eb9862-518c-4d50-a687-f6065301b3a8"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/28eb9862-518c-4d50-a687-f6065301b3a8",
"resource": {
"resourceType": "ClaimResponse",
"id": "28eb9862-518c-4d50-a687-f6065301b3a8",
"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": "rejected"
}
]
}
},
{
"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": "2069"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "28eb9862-518c-4d50-a687-f6065301b3a8"
}
],
"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/98dd6943-b9ad-4966-a302-b6e4720feb15"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/5a987992-4c45-44eb-9f76-0ba6615f8cc3"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/dd390df2-1c7b-4417-8e61-ea43755ec58f"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "32276936260924"
}
},
"outcome": "complete",
"disposition": "-",
"item": [
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
"code": "rejected"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "97198"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"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": "copay"
}
]
},
"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": "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": 40.14,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
"code": "approved-quantity"
}
]
},
"value": 0
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 40.14,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"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": 0,
"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"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "https://tawuniya.com.sa/Coverage/9db3bf87-8f74-4ea7-b384-16d9943f1798"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/98dd6943-b9ad-4966-a302-b6e4720feb15",
"resource": {
"resourceType": "Patient",
"id": "98dd6943-b9ad-4966-a302-b6e4720feb15",
"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": "1106324740"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "nada osama gamal",
"given": [
"nada",
"osama",
"gamal"
]
}
],
"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": "1999-12-12",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/dd390df2-1c7b-4417-8e61-ea43755ec58f",
"resource": {
"resourceType": "Organization",
"id": "dd390df2-1c7b-4417-8e61-ea43755ec58f",
"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/5a987992-4c45-44eb-9f76-0ba6615f8cc3",
"resource": {
"resourceType": "Organization",
"id": "5a987992-4c45-44eb-9f76-0ba6615f8cc3",
"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/9db3bf87-8f74-4ea7-b384-16d9943f1798",
"resource": {
"resourceType": "Coverage",
"id": "9db3bf87-8f74-4ea7-b384-16d9943f1798",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "001098843418101"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/075c13c3-7100-4df8-9899-a72a9b284e3b"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/d1587bea-8b57-448c-ad60-b606532163aa"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/98dd6943-b9ad-4966-a302-b6e4720feb15"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/5a987992-4c45-44eb-9f76-0ba6615f8cc3"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "50115090",
"name": "SAMI AIRBUS AIRCRAFT MAINTENANCE SERVICE"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/075c13c3-7100-4df8-9899-a72a9b284e3b",
"resource": {
"resourceType": "Organization",
"id": "075c13c3-7100-4df8-9899-a72a9b284e3b",
"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/d1587bea-8b57-448c-ad60-b606532163aa",
"resource": {
"resourceType": "Patient",
"id": "d1587bea-8b57-448c-ad60-b606532163aa",
"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": "1106324740"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "nada osama gamal",
"given": [
"nada",
"osama",
"gamal"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0544241984"
}
],
"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": "1999-12-12",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/eabce18b-99a3-4681-b42a-00a88ce1cb50",
"resource": {
"resourceType": "Bundle",
"id": "eabce18b-99a3-4681-b42a-00a88ce1cb50",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.406\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/238bc82e-5937-427f-b35c-fecca415ad50",
"resource": {
"resourceType": "MessageHeader",
"id": "238bc82e-5937-427f-b35c-fecca415ad50",
"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": "6d4767e1-60bc-4c57-9511-9f7c23c2bcd0",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/bb150822-0669-4de1-a646-2305a449c9b7"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/bb150822-0669-4de1-a646-2305a449c9b7",
"resource": {
"resourceType": "ClaimResponse",
"id": "bb150822-0669-4de1-a646-2305a449c9b7",
"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": "2032"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "bb150822-0669-4de1-a646-2305a449c9b7"
}
],
"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/ec828024-7e03-4ec8-a042-529a2bdf6c6d"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/da87f486-c027-4683-816f-c2d3c42118dc"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/bc92dc43-a7d1-421d-bad8-298426298045"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "4276072260924"
}
},
"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": "96897"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 2.77,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 3.46,
"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": 0.69,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 3.46,
"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": "96897"
}
}
],
"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": 6.43,
"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": 6.43,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.29,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 5.14,
"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": "rejected"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "96897"
}
}
],
"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": 1.59,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 7.96,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 7.96,
"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": "96897"
}
}
],
"itemSequence": 4,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 31.72,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 25.38,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 6.34,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 31.72,
"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": "96897"
}
}
],
"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": 8.89,
"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": "eligible"
}
]
},
"amount": {
"value": 11.11,
"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": "96897"
}
}
],
"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": 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://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": "96897"
}
}
],
"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": 8.26,
"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": "submitted"
}
]
},
"amount": {
"value": 8.26,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 5.9,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "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": 109.71,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 48.08,
"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": 21.76,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 109.71,
"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/53828cbf-749f-4af0-9211-045d2f1a7907"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/ec828024-7e03-4ec8-a042-529a2bdf6c6d",
"resource": {
"resourceType": "Patient",
"id": "ec828024-7e03-4ec8-a042-529a2bdf6c6d",
"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": "2576591651"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "muhammad ABDU Al-Nasser",
"given": [
"muhammad",
"ABDU",
"Al-Nasser"
]
}
],
"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": "2000-02-11",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/bc92dc43-a7d1-421d-bad8-298426298045",
"resource": {
"resourceType": "Organization",
"id": "bc92dc43-a7d1-421d-bad8-298426298045",
"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/da87f486-c027-4683-816f-c2d3c42118dc",
"resource": {
"resourceType": "Organization",
"id": "da87f486-c027-4683-816f-c2d3c42118dc",
"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/53828cbf-749f-4af0-9211-045d2f1a7907",
"resource": {
"resourceType": "Coverage",
"id": "53828cbf-749f-4af0-9211-045d2f1a7907",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002576591651001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/b737bf8d-c6d4-45e1-919f-0df2d72d14bc"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/3f155964-6af6-4386-a620-e678975c4d1a"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/ec828024-7e03-4ec8-a042-529a2bdf6c6d"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/da87f486-c027-4683-816f-c2d3c42118dc"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "53115951",
"name": "NRTC Company Limited"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/b737bf8d-c6d4-45e1-919f-0df2d72d14bc",
"resource": {
"resourceType": "Organization",
"id": "b737bf8d-c6d4-45e1-919f-0df2d72d14bc",
"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/3f155964-6af6-4386-a620-e678975c4d1a",
"resource": {
"resourceType": "Patient",
"id": "3f155964-6af6-4386-a620-e678975c4d1a",
"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": "2576591651"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "muhammad ABDU Al-Nasser",
"given": [
"muhammad",
"ABDU",
"Al-Nasser"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0533788776"
}
],
"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": "2000-02-11",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/d592211c-9ee4-4d24-97b5-6a014a7ea49f",
"resource": {
"resourceType": "Bundle",
"id": "d592211c-9ee4-4d24-97b5-6a014a7ea49f",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.435\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/357ea705-0363-442c-b90b-b3bcfcd8119d",
"resource": {
"resourceType": "MessageHeader",
"id": "357ea705-0363-442c-b90b-b3bcfcd8119d",
"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": "cd9fd7c6-bf91-4d49-adaa-cde63d380804",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/46cb2b0b-ba67-45bc-9ec3-577518d06856"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/46cb2b0b-ba67-45bc-9ec3-577518d06856",
"resource": {
"resourceType": "ClaimResponse",
"id": "46cb2b0b-ba67-45bc-9ec3-577518d06856",
"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": "2422"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "46cb2b0b-ba67-45bc-9ec3-577518d06856"
}
],
"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/7b27a8f4-ebd0-49bc-b67f-edfa2684410d"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/25a768be-23a2-4ef3-9c90-488e66cb63b0"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/bb0459fb-68d5-4be7-951b-f383b6d89b9a"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "69286691260928"
}
},
"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": "100930"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 7.2,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 10.08,
"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": 10.08,
"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": 1.8,
"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": "100930"
}
}
],
"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": 4.54,
"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": "submitted"
}
]
},
"amount": {
"value": 6.35,
"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
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 16.43,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 11.74,
"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": 2.93,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 16.43,
"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/6808c711-be3a-4c36-a4ff-43dd8c912f04"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/7b27a8f4-ebd0-49bc-b67f-edfa2684410d",
"resource": {
"resourceType": "Patient",
"id": "7b27a8f4-ebd0-49bc-b67f-edfa2684410d",
"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": "1098314303"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "abdrhman muhammad OWAD",
"given": [
"abdrhman",
"muhammad",
"OWAD"
]
}
],
"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": "1998-02-03",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/bb0459fb-68d5-4be7-951b-f383b6d89b9a",
"resource": {
"resourceType": "Organization",
"id": "bb0459fb-68d5-4be7-951b-f383b6d89b9a",
"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/25a768be-23a2-4ef3-9c90-488e66cb63b0",
"resource": {
"resourceType": "Organization",
"id": "25a768be-23a2-4ef3-9c90-488e66cb63b0",
"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/6808c711-be3a-4c36-a4ff-43dd8c912f04",
"resource": {
"resourceType": "Coverage",
"id": "6808c711-be3a-4c36-a4ff-43dd8c912f04",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "001098314303001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/4f68d764-b36d-4982-bf85-2fe0ea0c1204"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/f60e6e1c-5d63-4572-ae69-062501942a3a"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/7b27a8f4-ebd0-49bc-b67f-edfa2684410d"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/25a768be-23a2-4ef3-9c90-488e66cb63b0"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "55002791",
"name": "Hani Youssef Yacoub Basic B"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/4f68d764-b36d-4982-bf85-2fe0ea0c1204",
"resource": {
"resourceType": "Organization",
"id": "4f68d764-b36d-4982-bf85-2fe0ea0c1204",
"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/f60e6e1c-5d63-4572-ae69-062501942a3a",
"resource": {
"resourceType": "Patient",
"id": "f60e6e1c-5d63-4572-ae69-062501942a3a",
"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": "1098314303"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "abdrhman muhammad OWAD",
"given": [
"abdrhman",
"muhammad",
"OWAD"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0549448868"
}
],
"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": "1998-02-03",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/c94396eb-f13c-4480-9615-4aadf6261f56",
"resource": {
"resourceType": "Bundle",
"id": "c94396eb-f13c-4480-9615-4aadf6261f56",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.539\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/8f89e04e-771b-4982-9a38-d7c9e98b52eb",
"resource": {
"resourceType": "MessageHeader",
"id": "8f89e04e-771b-4982-9a38-d7c9e98b52eb",
"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": "3a6e8d84-9aab-474d-9b6d-cc89bcaee275",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/7e1c7756-84ae-4b81-bc95-c0963ef2beb0"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/7e1c7756-84ae-4b81-bc95-c0963ef2beb0",
"resource": {
"resourceType": "ClaimResponse",
"id": "7e1c7756-84ae-4b81-bc95-c0963ef2beb0",
"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": "1710"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "7e1c7756-84ae-4b81-bc95-c0963ef2beb0"
}
],
"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/96e168bb-457f-489c-ab7a-201bf7efee7d"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/8d4ad2ff-b43b-4008-af6c-8c8072a85aa5"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/962b023d-b739-4605-8691-1701cb35d403"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "70267257260920"
}
},
"outcome": "complete",
"disposition": "-",
"item": [
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
"code": "rejected"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "93491"
}
}
],
"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": 4.95,
"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": "copay"
}
]
},
"amount": {
"value": 0.99,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 4.95,
"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": "rejected"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "93491"
}
}
],
"itemSequence": 2,
"adjudication": [
{
"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": "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": "MN-1-1"
}
]
},
"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": "copay"
}
]
},
"amount": {
"value": 2.22,
"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": "rejected"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "93491"
}
}
],
"itemSequence": 3,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 37.67,
"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": "eligible"
}
]
},
"amount": {
"value": 37.67,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "AD-2-4"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 7.53,
"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": "93491"
}
}
],
"itemSequence": 4,
"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": "deductible"
}
]
},
"amount": {
"value": 0,
"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": "benefit"
}
]
},
"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": "approved"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "93491"
}
}
],
"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": 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": "submitted"
}
]
},
"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://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": "93491"
}
}
],
"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": 40.77,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 8.15,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 40.77,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "AD-2-4"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "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": 112.86,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 14.15,
"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": 22.42,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 112.86,
"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/cbe50106-faba-4151-a921-cd0e48e2c5e2"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/96e168bb-457f-489c-ab7a-201bf7efee7d",
"resource": {
"resourceType": "Patient",
"id": "96e168bb-457f-489c-ab7a-201bf7efee7d",
"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": "2577497338"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "LIYAN abdamuhsen abdamuhsen",
"given": [
"LIYAN",
"abdamuhsen",
"abdamuhsen"
]
}
],
"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": "2020-06-28",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/962b023d-b739-4605-8691-1701cb35d403",
"resource": {
"resourceType": "Organization",
"id": "962b023d-b739-4605-8691-1701cb35d403",
"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/8d4ad2ff-b43b-4008-af6c-8c8072a85aa5",
"resource": {
"resourceType": "Organization",
"id": "8d4ad2ff-b43b-4008-af6c-8c8072a85aa5",
"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/cbe50106-faba-4151-a921-cd0e48e2c5e2",
"resource": {
"resourceType": "Coverage",
"id": "cbe50106-faba-4151-a921-cd0e48e2c5e2",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002103321945221"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/a4b759a0-c2be-4fc0-9ffb-97f270f9fa39"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/d50a9515-95df-4cda-92a7-93feefd6a376"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/96e168bb-457f-489c-ab7a-201bf7efee7d"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/8d4ad2ff-b43b-4008-af6c-8c8072a85aa5"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "52418191",
"name": "Osama Azraq Foundation for Operation and"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/a4b759a0-c2be-4fc0-9ffb-97f270f9fa39",
"resource": {
"resourceType": "Organization",
"id": "a4b759a0-c2be-4fc0-9ffb-97f270f9fa39",
"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/d50a9515-95df-4cda-92a7-93feefd6a376",
"resource": {
"resourceType": "Patient",
"id": "d50a9515-95df-4cda-92a7-93feefd6a376",
"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": "2577497338"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "LIYAN abdamuhsen abdamuhsen",
"given": [
"LIYAN",
"abdamuhsen",
"abdamuhsen"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0553550024"
}
],
"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": "2020-06-28",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/95ed4f22-aee5-4c25-a229-39a93ef3f492",
"resource": {
"resourceType": "Bundle",
"id": "95ed4f22-aee5-4c25-a229-39a93ef3f492",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.684\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/9dafd04c-b79d-432b-97c3-b00914d355db",
"resource": {
"resourceType": "MessageHeader",
"id": "9dafd04c-b79d-432b-97c3-b00914d355db",
"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": "9421c20b-bcfd-4041-816e-ab2acdd5ec0f",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/b0b06fa2-ad9d-4289-81cf-69108e957fbd"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/b0b06fa2-ad9d-4289-81cf-69108e957fbd",
"resource": {
"resourceType": "ClaimResponse",
"id": "b0b06fa2-ad9d-4289-81cf-69108e957fbd",
"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": "2517"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "b0b06fa2-ad9d-4289-81cf-69108e957fbd"
}
],
"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/e739d4ec-7c82-4be5-ac1d-ade21da22e3e"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/952d32a6-854c-44a0-9583-e58a536e6bc6"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/591f8ecb-9615-4022-8995-3a167ac965de"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "73290206260929"
}
},
"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": "102043"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 28.35,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 32.6,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 32.6,
"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": "copay"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
"code": "approved-quantity"
}
]
},
"value": 5
}
]
},
{
"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": "102043"
}
}
],
"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": 139.2,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 30,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 169.2,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 169.2,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
"code": "approved-quantity"
}
]
},
"value": 2
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 201.8,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 167.55,
"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": 30,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 201.8,
"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/09c043df-a7c9-43f7-9689-f674ec186f69"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/e739d4ec-7c82-4be5-ac1d-ade21da22e3e",
"resource": {
"resourceType": "Patient",
"id": "e739d4ec-7c82-4be5-ac1d-ade21da22e3e",
"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": "1129280069"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "IBRAR abdulwahid ALHARBI",
"given": [
"IBRAR",
"abdulwahid",
"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": "2005-05-04",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/591f8ecb-9615-4022-8995-3a167ac965de",
"resource": {
"resourceType": "Organization",
"id": "591f8ecb-9615-4022-8995-3a167ac965de",
"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/952d32a6-854c-44a0-9583-e58a536e6bc6",
"resource": {
"resourceType": "Organization",
"id": "952d32a6-854c-44a0-9583-e58a536e6bc6",
"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/09c043df-a7c9-43f7-9689-f674ec186f69",
"resource": {
"resourceType": "Coverage",
"id": "09c043df-a7c9-43f7-9689-f674ec186f69",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "001086148689101"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/920bfbfb-8f8a-41c8-95fa-5dfb320c5c51"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/c55598ed-6096-42f5-8665-469ea3be46b7"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/e739d4ec-7c82-4be5-ac1d-ade21da22e3e"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/952d32a6-854c-44a0-9583-e58a536e6bc6"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "52259342",
"name": "AL KISWAH TOWERS HOTEL"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/920bfbfb-8f8a-41c8-95fa-5dfb320c5c51",
"resource": {
"resourceType": "Organization",
"id": "920bfbfb-8f8a-41c8-95fa-5dfb320c5c51",
"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/c55598ed-6096-42f5-8665-469ea3be46b7",
"resource": {
"resourceType": "Patient",
"id": "c55598ed-6096-42f5-8665-469ea3be46b7",
"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": "1129280069"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "IBRAR abdulwahid ALHARBI",
"given": [
"IBRAR",
"abdulwahid",
"ALHARBI"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0566685277"
}
],
"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": "2005-05-04",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/330448eb-146e-4195-95fd-f7aebddcbf9e",
"resource": {
"resourceType": "Bundle",
"id": "330448eb-146e-4195-95fd-f7aebddcbf9e",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.669\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/f4bc3ca5-5cc7-4424-a99a-5bcdf4459837",
"resource": {
"resourceType": "MessageHeader",
"id": "f4bc3ca5-5cc7-4424-a99a-5bcdf4459837",
"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": "e11bfd0b-64a6-457c-977c-b23eb08a56c4",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/dcefdd15-ebb2-48d5-ab91-f3662b459e60"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/dcefdd15-ebb2-48d5-ab91-f3662b459e60",
"resource": {
"resourceType": "ClaimResponse",
"id": "dcefdd15-ebb2-48d5-ab91-f3662b459e60",
"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": "1127"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "dcefdd15-ebb2-48d5-ab91-f3662b459e60"
}
],
"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/dcc392b4-dd6a-407d-af7c-0b054fd666d4"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/5b7d4bb2-c723-4f7d-9889-c0c11ab96ee2"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/307fa0ed-b491-43ea-bbc2-6f6d845eb205"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "43250607260914"
}
},
"outcome": "complete",
"disposition": "-",
"item": [
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
"code": "rejected"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "87214"
}
}
],
"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": 83.38,
"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": "copay"
}
]
},
"amount": {
"value": 16.68,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 83.38,
"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": "87214"
}
}
],
"itemSequence": 2,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 14.22,
"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": 11.38,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 14.22,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 2.84,
"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": "87214"
}
}
],
"itemSequence": 3,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 131.74,
"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": 131.74,
"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": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 23.53,
"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": "87214"
}
}
],
"itemSequence": 4,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 17.91,
"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": 17.91,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 3.58,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 14.33,
"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": "87214"
}
}
],
"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": 12.8,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 2.29,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 12.8,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "MN-1-1"
}
]
},
"amount": {
"value": 0,
"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": "87214"
}
}
],
"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": 7.01,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.25,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 7.01,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 5.01,
"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": 267.06,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 30.72,
"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": 50.17,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 267.06,
"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/abf0aa36-d21f-4e92-a6aa-ddf1f3a6b63c"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/dcc392b4-dd6a-407d-af7c-0b054fd666d4",
"resource": {
"resourceType": "Patient",
"id": "dcc392b4-dd6a-407d-af7c-0b054fd666d4",
"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": "1061872204"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "abdallah musaed ALANSARY",
"given": [
"abdallah",
"musaed",
"ALANSARY"
]
}
],
"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": "1989-05-20",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/307fa0ed-b491-43ea-bbc2-6f6d845eb205",
"resource": {
"resourceType": "Organization",
"id": "307fa0ed-b491-43ea-bbc2-6f6d845eb205",
"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/5b7d4bb2-c723-4f7d-9889-c0c11ab96ee2",
"resource": {
"resourceType": "Organization",
"id": "5b7d4bb2-c723-4f7d-9889-c0c11ab96ee2",
"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/abf0aa36-d21f-4e92-a6aa-ddf1f3a6b63c",
"resource": {
"resourceType": "Coverage",
"id": "abf0aa36-d21f-4e92-a6aa-ddf1f3a6b63c",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "001061872204001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/aa6dc56c-874d-48c1-8ec4-67693912af11"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/cd13b878-64b5-4fa6-97af-358f4d07b39d"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/dcc392b4-dd6a-407d-af7c-0b054fd666d4"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/5b7d4bb2-c723-4f7d-9889-c0c11ab96ee2"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "56252406",
"name": "MODERN ACHITECHTURAL CONTRACTING COMPANY"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/aa6dc56c-874d-48c1-8ec4-67693912af11",
"resource": {
"resourceType": "Organization",
"id": "aa6dc56c-874d-48c1-8ec4-67693912af11",
"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/cd13b878-64b5-4fa6-97af-358f4d07b39d",
"resource": {
"resourceType": "Patient",
"id": "cd13b878-64b5-4fa6-97af-358f4d07b39d",
"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": "1061872204"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "abdallah musaed ALANSARY",
"given": [
"abdallah",
"musaed",
"ALANSARY"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0505506599"
}
],
"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": "1989-05-20",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/86354706-9e62-453f-97e8-f77014ed514d",
"resource": {
"resourceType": "Bundle",
"id": "86354706-9e62-453f-97e8-f77014ed514d",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.726\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/b7aa8e22-1fff-4d23-b9c7-b5e32480cab0",
"resource": {
"resourceType": "MessageHeader",
"id": "b7aa8e22-1fff-4d23-b9c7-b5e32480cab0",
"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": "43068f8f-abfe-4b5e-aee1-fd4714701820",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/05244210-af63-47d5-9217-aa95fea8eb85"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/05244210-af63-47d5-9217-aa95fea8eb85",
"resource": {
"resourceType": "ClaimResponse",
"id": "05244210-af63-47d5-9217-aa95fea8eb85",
"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": "rejected"
}
]
}
},
{
"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": "2701"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "05244210-af63-47d5-9217-aa95fea8eb85"
}
],
"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/c79675e8-a40e-4477-a3f1-41c907753f8f"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/e4b0d3ee-4e96-409a-90f8-4dabfc0f821b"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/f51a2f85-7ec2-4797-8226-90c819d43fbf"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "36295778260930"
}
},
"outcome": "complete",
"disposition": "-",
"item": [
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
"code": "rejected"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "103846"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "CV-1-3"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 24.52,
"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": 24.52,
"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": "copay"
}
]
},
"amount": {
"value": 4.9,
"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": "103846"
}
}
],
"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"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "CV-1-3"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.35,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 6.75,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 6.75,
"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": 31.27,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"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": 6.25,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 31.27,
"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/abe43abb-78e7-44bd-959a-86600ec7b914"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/c79675e8-a40e-4477-a3f1-41c907753f8f",
"resource": {
"resourceType": "Patient",
"id": "c79675e8-a40e-4477-a3f1-41c907753f8f",
"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": "2175975107"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "SARAH noor ULISLAM ULISLAM",
"given": [
"SARAH",
"ULISLAM",
"ULISLAM"
]
}
],
"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": "1997-10-06",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/f51a2f85-7ec2-4797-8226-90c819d43fbf",
"resource": {
"resourceType": "Organization",
"id": "f51a2f85-7ec2-4797-8226-90c819d43fbf",
"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/e4b0d3ee-4e96-409a-90f8-4dabfc0f821b",
"resource": {
"resourceType": "Organization",
"id": "e4b0d3ee-4e96-409a-90f8-4dabfc0f821b",
"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/abe43abb-78e7-44bd-959a-86600ec7b914",
"resource": {
"resourceType": "Coverage",
"id": "abe43abb-78e7-44bd-959a-86600ec7b914",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002143112437101"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/31110b94-ba6e-4102-85c1-22cbaca59a45"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/c9a46e26-f21a-4ed3-9e1f-ed181d69f752"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/c79675e8-a40e-4477-a3f1-41c907753f8f"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/e4b0d3ee-4e96-409a-90f8-4dabfc0f821b"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "53081113",
"name": "TRADEMARKS SOLUTIONS"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/31110b94-ba6e-4102-85c1-22cbaca59a45",
"resource": {
"resourceType": "Organization",
"id": "31110b94-ba6e-4102-85c1-22cbaca59a45",
"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/c9a46e26-f21a-4ed3-9e1f-ed181d69f752",
"resource": {
"resourceType": "Patient",
"id": "c9a46e26-f21a-4ed3-9e1f-ed181d69f752",
"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": "2175975107"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "SARAH noor ULISLAM ULISLAM",
"given": [
"SARAH",
"ULISLAM",
"ULISLAM"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0553550322"
}
],
"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": "1997-10-06",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/d6ffc1ff-7140-4e6e-ac73-07efb8a33928",
"resource": {
"resourceType": "Bundle",
"id": "d6ffc1ff-7140-4e6e-ac73-07efb8a33928",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.704\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/03f62d2d-a015-40a7-8fe8-f17add6a5f40",
"resource": {
"resourceType": "MessageHeader",
"id": "03f62d2d-a015-40a7-8fe8-f17add6a5f40",
"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": "9888618e-65e5-4bef-8cde-d195a91a3a4c",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/feac2023-b0cf-486d-abee-47afb4b2d692"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/feac2023-b0cf-486d-abee-47afb4b2d692",
"resource": {
"resourceType": "ClaimResponse",
"id": "feac2023-b0cf-486d-abee-47afb4b2d692",
"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": "2387"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "feac2023-b0cf-486d-abee-47afb4b2d692"
}
],
"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/3efb94f0-fc1f-4c95-b2d4-1b0478cf36a1"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/4be67b8e-8c72-45ea-a21a-3fe877c19167"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/cae57fd7-bd2f-4bc1-9204-e610ec253061"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "97285900260927"
}
},
"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": "100542"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 5.9,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 8.26,
"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": 1.48,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 8.26,
"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": "100542"
}
}
],
"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": "approved"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "100542"
}
}
],
"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": 1.17,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 5.85,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 5.85,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 4.68,
"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": "100542"
}
}
],
"itemSequence": 4,
"adjudication": [
{
"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": "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": "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": 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": "100542"
}
}
],
"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": 5.43,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 6.79,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.36,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 6.79,
"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": "100542"
}
}
],
"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": 4.54,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 0.91,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 4.54,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 3.63,
"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": "100542"
}
}
],
"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": 40.14,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 8.03,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 40.14,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 32.11,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "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": 117.46,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 51.75,
"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": 23.32,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 117.46,
"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/bb3aeb28-a0f6-47f8-beac-a583ed6c7e5c"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/3efb94f0-fc1f-4c95-b2d4-1b0478cf36a1",
"resource": {
"resourceType": "Patient",
"id": "3efb94f0-fc1f-4c95-b2d4-1b0478cf36a1",
"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": "2134467279"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "ATEEQ ALLAH ghulam ghulam",
"given": [
"ATEEQ",
"ghulam",
"ghulam"
]
}
],
"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": "1995-09-26",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/cae57fd7-bd2f-4bc1-9204-e610ec253061",
"resource": {
"resourceType": "Organization",
"id": "cae57fd7-bd2f-4bc1-9204-e610ec253061",
"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/4be67b8e-8c72-45ea-a21a-3fe877c19167",
"resource": {
"resourceType": "Organization",
"id": "4be67b8e-8c72-45ea-a21a-3fe877c19167",
"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/bb3aeb28-a0f6-47f8-beac-a583ed6c7e5c",
"resource": {
"resourceType": "Coverage",
"id": "bb3aeb28-a0f6-47f8-beac-a583ed6c7e5c",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002134467279001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/fd27c399-2f19-4cfb-8ad3-73272185decf"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/65397561-d0ec-4ecb-bc0c-1c1b882a2d9b"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/3efb94f0-fc1f-4c95-b2d4-1b0478cf36a1"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/4be67b8e-8c72-45ea-a21a-3fe877c19167"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "54884368",
"name": "Abdullah Ali Al Anzi Tree Micro Crystal"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/fd27c399-2f19-4cfb-8ad3-73272185decf",
"resource": {
"resourceType": "Organization",
"id": "fd27c399-2f19-4cfb-8ad3-73272185decf",
"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/65397561-d0ec-4ecb-bc0c-1c1b882a2d9b",
"resource": {
"resourceType": "Patient",
"id": "65397561-d0ec-4ecb-bc0c-1c1b882a2d9b",
"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": "2134467279"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "ATEEQ ALLAH ghulam ghulam",
"given": [
"ATEEQ",
"ghulam",
"ghulam"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0565919000"
}
],
"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": "1995-09-26",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/12d34790-915f-422c-90c6-010d11bf3d5b",
"resource": {
"resourceType": "Bundle",
"id": "12d34790-915f-422c-90c6-010d11bf3d5b",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.724\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/e45aea26-1c62-4014-aed9-2eab6d62165e",
"resource": {
"resourceType": "MessageHeader",
"id": "e45aea26-1c62-4014-aed9-2eab6d62165e",
"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": "2e40e071-2331-426f-8b97-f3647ddbe06d",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/4372b3fd-81b4-4d0b-9a1f-05e799829eb6"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/4372b3fd-81b4-4d0b-9a1f-05e799829eb6",
"resource": {
"resourceType": "ClaimResponse",
"id": "4372b3fd-81b4-4d0b-9a1f-05e799829eb6",
"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": "2322"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "4372b3fd-81b4-4d0b-9a1f-05e799829eb6"
}
],
"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/6e015fde-b94f-42fa-baa7-b847dc3a46c7"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/48e8d082-dded-44d4-a697-30d35f70db01"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/1ef65504-a112-4cc2-9d6d-6e049a514a12"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "79283890260927"
}
},
"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": "99901"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 17.55,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 3.51,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 14.04,
"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": 2.11,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 17.55,
"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": 17.55,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 14.04,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 3.51,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 17.55,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 2.11,
"currency": "SAR"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "https://tawuniya.com.sa/Coverage/ea090e82-3113-4d08-8fd1-55eda42da2f2"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/6e015fde-b94f-42fa-baa7-b847dc3a46c7",
"resource": {
"resourceType": "Patient",
"id": "6e015fde-b94f-42fa-baa7-b847dc3a46c7",
"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": "2102646763"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "FATIMA SAIF SAIFUL ABDULGHANI",
"given": [
"FATIMA",
"SAIFUL",
"ABDULGHANI"
]
}
],
"gender": "female",
"_gender": {
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code": "female",
"display": "female"
}
]
}
}
]
},
"birthDate": "1993-07-21",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/1ef65504-a112-4cc2-9d6d-6e049a514a12",
"resource": {
"resourceType": "Organization",
"id": "1ef65504-a112-4cc2-9d6d-6e049a514a12",
"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/48e8d082-dded-44d4-a697-30d35f70db01",
"resource": {
"resourceType": "Organization",
"id": "48e8d082-dded-44d4-a697-30d35f70db01",
"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/ea090e82-3113-4d08-8fd1-55eda42da2f2",
"resource": {
"resourceType": "Coverage",
"id": "ea090e82-3113-4d08-8fd1-55eda42da2f2",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002051502967211"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/44da931d-d42a-48c8-b7e1-f7c6edb9a214"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/c8bac54b-4b55-4371-9572-987e8cb817f2"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/6e015fde-b94f-42fa-baa7-b847dc3a46c7"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/48e8d082-dded-44d4-a697-30d35f70db01"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "54713500",
"name": "Al Bari Al Mumta a T Tree Micro Basic A"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/44da931d-d42a-48c8-b7e1-f7c6edb9a214",
"resource": {
"resourceType": "Organization",
"id": "44da931d-d42a-48c8-b7e1-f7c6edb9a214",
"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/c8bac54b-4b55-4371-9572-987e8cb817f2",
"resource": {
"resourceType": "Patient",
"id": "c8bac54b-4b55-4371-9572-987e8cb817f2",
"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": "2102646763"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "FATIMA SAIF SAIFUL ABDULGHANI",
"given": [
"FATIMA",
"SAIFUL",
"ABDULGHANI"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0507184205"
}
],
"gender": "female",
"_gender": {
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code": "female",
"display": "female"
}
]
}
}
]
},
"birthDate": "1993-07-21",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/f5ec51b9-c5ef-4c5c-af0f-547fbcb068e5",
"resource": {
"resourceType": "Bundle",
"id": "f5ec51b9-c5ef-4c5c-af0f-547fbcb068e5",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:55:11.760\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/758d293e-fe61-44b9-a53d-8260b619b790",
"resource": {
"resourceType": "MessageHeader",
"id": "758d293e-fe61-44b9-a53d-8260b619b790",
"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": "cd57aacf-2efa-4804-a65b-7447fbd4b19c",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/c67b5a3f-3787-42de-b841-86327e048311"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/c67b5a3f-3787-42de-b841-86327e048311",
"resource": {
"resourceType": "ClaimResponse",
"id": "c67b5a3f-3787-42de-b841-86327e048311",
"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": "2585"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "c67b5a3f-3787-42de-b841-86327e048311"
}
],
"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/12739807-d57c-4a7a-a2e7-1e749c9cf9da"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/18fdf0ec-8600-4745-a267-7fc6c6e3fc54"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/1c5b10b8-277c-4b9b-8531-b996b83644f4"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "95292031260929"
}
},
"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": "102584"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 27.04,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 5.41,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 27.04,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 21.63,
"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": "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": "102584"
}
}
],
"itemSequence": 2,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 7.02,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 7.02,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 5.62,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.4,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
"code": "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": "102584"
}
}
],
"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": 21.87,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 4.37,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 21.87,
"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": "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": "rejected"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "102584"
}
}
],
"itemSequence": 4,
"adjudication": [
{
"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": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 2.07,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 10.35,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 10.35,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
"code": "approved-quantity"
}
]
},
"value": 0
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 66.28,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 27.25,
"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": 13.25,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 66.28,
"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/7abfd726-ff3d-41ce-b2a2-5fb4025b814b"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/12739807-d57c-4a7a-a2e7-1e749c9cf9da",
"resource": {
"resourceType": "Patient",
"id": "12739807-d57c-4a7a-a2e7-1e749c9cf9da",
"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": "2576293373"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "mehmood ahmed mehmood",
"given": [
"mehmood",
"ahmed",
"mehmood"
]
}
],
"gender": "male",
"_gender": {
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code": "male",
"display": "male"
}
]
}
}
]
},
"birthDate": "1978-10-10",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/1c5b10b8-277c-4b9b-8531-b996b83644f4",
"resource": {
"resourceType": "Organization",
"id": "1c5b10b8-277c-4b9b-8531-b996b83644f4",
"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/18fdf0ec-8600-4745-a267-7fc6c6e3fc54",
"resource": {
"resourceType": "Organization",
"id": "18fdf0ec-8600-4745-a267-7fc6c6e3fc54",
"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/7abfd726-ff3d-41ce-b2a2-5fb4025b814b",
"resource": {
"resourceType": "Coverage",
"id": "7abfd726-ff3d-41ce-b2a2-5fb4025b814b",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002576293373001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/115f0b3d-0421-487c-bc93-3b527b6bc11c"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/a8cd258a-b892-44a9-96b0-a1a83a8745dd"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/12739807-d57c-4a7a-a2e7-1e749c9cf9da"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/18fdf0ec-8600-4745-a267-7fc6c6e3fc54"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "52714179",
"name": "Saudi Sands Company Bronze B"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/115f0b3d-0421-487c-bc93-3b527b6bc11c",
"resource": {
"resourceType": "Organization",
"id": "115f0b3d-0421-487c-bc93-3b527b6bc11c",
"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/a8cd258a-b892-44a9-96b0-a1a83a8745dd",
"resource": {
"resourceType": "Patient",
"id": "a8cd258a-b892-44a9-96b0-a1a83a8745dd",
"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": "2576293373"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "mehmood ahmed mehmood",
"given": [
"mehmood",
"ahmed",
"mehmood"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0534813105"
}
],
"gender": "male",
"_gender": {
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code": "male",
"display": "male"
}
]
}
}
]
},
"birthDate": "1978-10-10",
"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.