Error Al-Kholood Medical Company - AlHaj claim-response
All traces- Trace
- 85367d4e-5df7-46a6-a748-efb8273c7499
- Started
- 2026-10-30 02:52:55.431 +03:00
- Branch
- Al-Kholood Medical Company - AlHaj (9)
- Mode
- Middleware
- Service URL
- https://nphies.careofme.net/api/v1/nphies/send
- HTTP
- 200 in 1458 ms
- Bundle / Request
- ad24c9ee-4dfd-4153-a821-530c805cabca / 700671
- Parsed items
- 0
- Total duration
- 1462 ms
- Error
- Cannot open database "NitcoSysLog" requested by the login. The login failed. Login failed for user 'NitcoWebcenter'.
{
"resourceType": "Bundle",
"id": "ad24c9ee-4dfd-4153-a821-530c805cabca",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-30T02:52:55.43\u002B03:00",
"entry": [
{
"fullUrl": "urn:uuid:0578b283-673d-41cd-83c4-a241a66134fc",
"resource": {
"resourceType": "MessageHeader",
"id": "0578b283-673d-41cd-83c4-a241a66134fc",
"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/700671"
}
]
}
},
{
"fullUrl": "http://www.ALKholood.com/Task/700671",
"resource": {
"resourceType": "Task",
"id": "700671",
"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_920261030025255"
}
],
"status": "requested",
"intent": "order",
"priority": "stat",
"code": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/task-code",
"code": "poll"
}
]
},
"authoredOn": "2026-09-30",
"lastModified": "2026-10-30",
"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": "2026-10-30T23:59:59.999\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": "ad24c9ee-4dfd-4153-a821-530c805cabca"
}
{
"resourceType": "Bundle",
"id": "a05b25ab-5c48-444b-9531-23c374171d7a",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-30T02:52:56.618\u002B03:00",
"entry": [
{
"fullUrl": "http://nphies.sa/MessageHeader/bcd58c2a-d1ab-492c-9f4b-0bbed941a66a",
"resource": {
"resourceType": "MessageHeader",
"id": "bcd58c2a-d1ab-492c-9f4b-0bbed941a66a",
"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": "0578b283-673d-41cd-83c4-a241a66134fc",
"code": "ok"
}
}
},
{
"fullUrl": "http://nphies.sa/Task/5321bbd3-8684-4401-aa10-b93d4a60cd41",
"resource": {
"resourceType": "Task",
"id": "5321bbd3-8684-4401-aa10-b93d4a60cd41",
"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": "883"
}
],
"status": "completed",
"intent": "order",
"priority": "stat",
"code": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/task-code",
"code": "poll"
}
]
},
"authoredOn": "2026-09-30",
"lastModified": "2026-10-30",
"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": "2026-10-30T23:59:59.999\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": "2026-10-20T08:52:19.197\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/2c241aa3-b6e5-4ec5-983a-663466dc269d"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:52:19.272\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/8fced7b2-2c89-451c-aabe-3bda9041f22a"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:52:19.537\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/6c420679-74d9-4ce6-9bae-6ba89dcdedd0"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:52:19.762\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/d70c91dd-e1b1-4fa6-8cb7-76c1d7a2a4c8"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:52:19.881\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/8c2c1290-8ea6-419c-9621-4911b731314e"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:52:20.193\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/cf31bef3-1d36-4581-ac69-499404688e28"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:53:24.130\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/0c02aa48-be37-4de2-b0ed-b731c46d0389"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:53:24.178\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/29c0caba-1e8e-40df-bae2-c41e55458898"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:53:24.187\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/04a9a059-bd17-4f33-b79c-99a1e20260ec"
}
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp",
"valueDateTime": "2026-10-20T08:53:24.253\u002B00:00"
}
],
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/ValueSet/task-output-type",
"code": "response"
}
]
},
"valueReference": {
"reference": "http://nphies.sa/Bundle/b72d3723-c2ce-41dd-a078-5809185f0fcf"
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/2c241aa3-b6e5-4ec5-983a-663466dc269d",
"resource": {
"resourceType": "Bundle",
"id": "2c241aa3-b6e5-4ec5-983a-663466dc269d",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:52:17.351\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/cea7bd1e-c72a-4dee-9981-531d4009c782",
"resource": {
"resourceType": "MessageHeader",
"id": "cea7bd1e-c72a-4dee-9981-531d4009c782",
"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": "ca05e945-c848-42e1-8201-0c7004f7014c",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/7b339450-99ae-4c31-a5c3-7263ba76477b"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/7b339450-99ae-4c31-a5c3-7263ba76477b",
"resource": {
"resourceType": "ClaimResponse",
"id": "7b339450-99ae-4c31-a5c3-7263ba76477b",
"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": "989"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "7b339450-99ae-4c31-a5c3-7263ba76477b"
}
],
"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/1954bc9a-db7e-4b8b-90de-88b4f13a7537"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/2b67c211-ded3-4faa-ab52-bddd2bec0195"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/13776d76-b9b3-4d44-b5fc-06205af5600d"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "37246688260912"
}
},
"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": "85550"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "AD-2-4"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 8.19,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.64,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 8.19,
"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": "85550"
}
}
],
"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": "copay"
}
]
},
"amount": {
"value": 1.4,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 7.02,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "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://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": "85550"
}
}
],
"itemSequence": 3,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 16.02,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 12.82,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 3.2,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 16.02,
"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": 31.23,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 12.82,
"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": 6.24,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 31.23,
"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/be5d269d-9ec0-42d9-b09a-915426933494"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/1954bc9a-db7e-4b8b-90de-88b4f13a7537",
"resource": {
"resourceType": "Patient",
"id": "1954bc9a-db7e-4b8b-90de-88b4f13a7537",
"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": "2583517707"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "MOHAMMED ABDOU GALEB ALSLUY",
"given": [
"MOHAMMED",
"GALEB",
"ALSLUY"
]
}
],
"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": "1992-01-01",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/13776d76-b9b3-4d44-b5fc-06205af5600d",
"resource": {
"resourceType": "Organization",
"id": "13776d76-b9b3-4d44-b5fc-06205af5600d",
"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/2b67c211-ded3-4faa-ab52-bddd2bec0195",
"resource": {
"resourceType": "Organization",
"id": "2b67c211-ded3-4faa-ab52-bddd2bec0195",
"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/be5d269d-9ec0-42d9-b09a-915426933494",
"resource": {
"resourceType": "Coverage",
"id": "be5d269d-9ec0-42d9-b09a-915426933494",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002583517707001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/b3b8d16e-966c-4c84-acdf-6af4eb3aa8b0"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/a0756774-5222-4ab3-82f6-aaa6b443b42f"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/1954bc9a-db7e-4b8b-90de-88b4f13a7537"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/2b67c211-ded3-4faa-ab52-bddd2bec0195"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "53566000",
"name": "lana factory for ind Basic B"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/b3b8d16e-966c-4c84-acdf-6af4eb3aa8b0",
"resource": {
"resourceType": "Organization",
"id": "b3b8d16e-966c-4c84-acdf-6af4eb3aa8b0",
"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/a0756774-5222-4ab3-82f6-aaa6b443b42f",
"resource": {
"resourceType": "Patient",
"id": "a0756774-5222-4ab3-82f6-aaa6b443b42f",
"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": "2583517707"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "MOHAMMED ABDOU GALEB ALSLUY",
"given": [
"MOHAMMED",
"GALEB",
"ALSLUY"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0552841956"
}
],
"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": "1992-01-01",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/8fced7b2-2c89-451c-aabe-3bda9041f22a",
"resource": {
"resourceType": "Bundle",
"id": "8fced7b2-2c89-451c-aabe-3bda9041f22a",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:52:16.867\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/88b60e46-2058-437a-95dc-29788e52fbc3",
"resource": {
"resourceType": "MessageHeader",
"id": "88b60e46-2058-437a-95dc-29788e52fbc3",
"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": "bee09ad6-fdda-4e55-8aeb-4f7fa0f3740b",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/0ef3d0a1-cd9d-4cd7-982f-a2b431100e88"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/0ef3d0a1-cd9d-4cd7-982f-a2b431100e88",
"resource": {
"resourceType": "ClaimResponse",
"id": "0ef3d0a1-cd9d-4cd7-982f-a2b431100e88",
"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": "732"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "0ef3d0a1-cd9d-4cd7-982f-a2b431100e88"
}
],
"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/ffbcdf01-6304-4093-bac4-3bb4aed5d436"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/0a63e131-5fcf-4f4b-829a-55582e0b4a71"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/2a84c684-4b1b-4bf0-9fc9-df8e6a16f4a0"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "59239962260909"
}
},
"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": "82798"
}
}
],
"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-4-5"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 46.03,
"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": 46.03,
"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": 9.21,
"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": "82798"
}
}
],
"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": 3.63,
"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": "eligible"
}
]
},
"amount": {
"value": 4.54,
"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": 50.57,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 3.63,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 10.12,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 50.57,
"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/92a4907b-c47f-416e-9bdc-7c070d15d16d"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/ffbcdf01-6304-4093-bac4-3bb4aed5d436",
"resource": {
"resourceType": "Patient",
"id": "ffbcdf01-6304-4093-bac4-3bb4aed5d436",
"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": "1014036931"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "amin SAEAD sauad alharby",
"given": [
"amin",
"sauad",
"alharby"
]
}
],
"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": "1984-05-06",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/2a84c684-4b1b-4bf0-9fc9-df8e6a16f4a0",
"resource": {
"resourceType": "Organization",
"id": "2a84c684-4b1b-4bf0-9fc9-df8e6a16f4a0",
"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/0a63e131-5fcf-4f4b-829a-55582e0b4a71",
"resource": {
"resourceType": "Organization",
"id": "0a63e131-5fcf-4f4b-829a-55582e0b4a71",
"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/92a4907b-c47f-416e-9bdc-7c070d15d16d",
"resource": {
"resourceType": "Coverage",
"id": "92a4907b-c47f-416e-9bdc-7c070d15d16d",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "001014036931001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/f07dd483-a6bd-411c-82de-42a36908738c"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/5a5e12e7-d1c0-49f5-acb9-a158c14e6647"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/ffbcdf01-6304-4093-bac4-3bb4aed5d436"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/0a63e131-5fcf-4f4b-829a-55582e0b4a71"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "50678036",
"name": "KENAN ALARABIYAH EST"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/f07dd483-a6bd-411c-82de-42a36908738c",
"resource": {
"resourceType": "Organization",
"id": "f07dd483-a6bd-411c-82de-42a36908738c",
"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/5a5e12e7-d1c0-49f5-acb9-a158c14e6647",
"resource": {
"resourceType": "Patient",
"id": "5a5e12e7-d1c0-49f5-acb9-a158c14e6647",
"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": "1014036931"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "amin SAEAD sauad alharby",
"given": [
"amin",
"sauad",
"alharby"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0537516808"
}
],
"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": "1984-05-06",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/6c420679-74d9-4ce6-9bae-6ba89dcdedd0",
"resource": {
"resourceType": "Bundle",
"id": "6c420679-74d9-4ce6-9bae-6ba89dcdedd0",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:52:17.435\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/ee182062-3b4b-4f98-ba28-f8dc2b68c446",
"resource": {
"resourceType": "MessageHeader",
"id": "ee182062-3b4b-4f98-ba28-f8dc2b68c446",
"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": "e7e56d6c-efa1-43a5-ab38-82513d0c9e1b",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/6b56781f-7401-4b8c-beed-8c8137d53e30"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/6b56781f-7401-4b8c-beed-8c8137d53e30",
"resource": {
"resourceType": "ClaimResponse",
"id": "6b56781f-7401-4b8c-beed-8c8137d53e30",
"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": "2341"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "6b56781f-7401-4b8c-beed-8c8137d53e30"
}
],
"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/7e64a41f-15e6-4597-a133-8859f06c63df"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/20d17445-4c47-49fe-b728-21b3caa569e8"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/4ec61852-3b58-4643-b319-ff61d765fcc5"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "7284306260927"
}
},
"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": "100033"
}
}
],
"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": 8.03,
"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": "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://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": "100033"
}
}
],
"itemSequence": 2,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 32.58,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 32.58,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 26.06,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 6.52,
"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": "100033"
}
}
],
"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": 11.07,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 2.21,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 11.07,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "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
}
]
},
{
"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": "100033"
}
}
],
"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": "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://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 2.11,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 10.53,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 10.53,
"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": 94.32,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 26.06,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 18.87,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 94.32,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "https://tawuniya.com.sa/Coverage/144aec84-7955-437b-a3a1-b92a93a80c69"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/7e64a41f-15e6-4597-a133-8859f06c63df",
"resource": {
"resourceType": "Patient",
"id": "7e64a41f-15e6-4597-a133-8859f06c63df",
"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": "1125837359"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "ABDULSAMAD ABOBAKAR BAWDOD",
"given": [
"ABDULSAMAD",
"ABOBAKAR",
"BAWDOD"
]
}
],
"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": "2004-08-10",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/4ec61852-3b58-4643-b319-ff61d765fcc5",
"resource": {
"resourceType": "Organization",
"id": "4ec61852-3b58-4643-b319-ff61d765fcc5",
"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/20d17445-4c47-49fe-b728-21b3caa569e8",
"resource": {
"resourceType": "Organization",
"id": "20d17445-4c47-49fe-b728-21b3caa569e8",
"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/144aec84-7955-437b-a3a1-b92a93a80c69",
"resource": {
"resourceType": "Coverage",
"id": "144aec84-7955-437b-a3a1-b92a93a80c69",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "001125837359001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/a3de0713-396a-4d56-a960-bbd19c47841e"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/fa32c235-d0c3-4fe2-b1a5-8d00f3f8544c"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/7e64a41f-15e6-4597-a133-8859f06c63df"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/20d17445-4c47-49fe-b728-21b3caa569e8"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "53262756",
"name": "ALMUTLAK METAL INDSUTRIES CO"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/a3de0713-396a-4d56-a960-bbd19c47841e",
"resource": {
"resourceType": "Organization",
"id": "a3de0713-396a-4d56-a960-bbd19c47841e",
"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/fa32c235-d0c3-4fe2-b1a5-8d00f3f8544c",
"resource": {
"resourceType": "Patient",
"id": "fa32c235-d0c3-4fe2-b1a5-8d00f3f8544c",
"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": "1125837359"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "ABDULSAMAD ABOBAKAR BAWDOD",
"given": [
"ABDULSAMAD",
"ABOBAKAR",
"BAWDOD"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0540935260"
}
],
"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": "2004-08-10",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/d70c91dd-e1b1-4fa6-8cb7-76c1d7a2a4c8",
"resource": {
"resourceType": "Bundle",
"id": "d70c91dd-e1b1-4fa6-8cb7-76c1d7a2a4c8",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:52:17.590\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/8a068043-7cdd-415e-aeb7-e883f593d530",
"resource": {
"resourceType": "MessageHeader",
"id": "8a068043-7cdd-415e-aeb7-e883f593d530",
"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": "bede9c1e-bd94-4b27-9232-0ca67948b2f2",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/366a232e-e585-4ab0-8966-713d25514192"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/366a232e-e585-4ab0-8966-713d25514192",
"resource": {
"resourceType": "ClaimResponse",
"id": "366a232e-e585-4ab0-8966-713d25514192",
"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": "1217"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "366a232e-e585-4ab0-8966-713d25514192"
}
],
"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/29576bc3-41c7-433e-8ce8-72171b24d52a"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/b125383d-223f-4c4e-b463-fb1bf458b89d"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/1865835b-545a-4085-b472-53efba2c2666"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "14253407260915"
}
},
"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": "88246"
}
}
],
"itemSequence": 1,
"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": "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": "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": 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": 6.35,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 4.54,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.13,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 6.35,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "https://tawuniya.com.sa/Coverage/1486477c-e592-458f-8fd6-7ac1f7276e94"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/29576bc3-41c7-433e-8ce8-72171b24d52a",
"resource": {
"resourceType": "Patient",
"id": "29576bc3-41c7-433e-8ce8-72171b24d52a",
"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": "2125637708"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "KARIMAH SAFAR abdasis abdasis",
"given": [
"KARIMAH",
"abdasis",
"abdasis"
]
}
],
"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": "1988-01-09",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/1865835b-545a-4085-b472-53efba2c2666",
"resource": {
"resourceType": "Organization",
"id": "1865835b-545a-4085-b472-53efba2c2666",
"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/b125383d-223f-4c4e-b463-fb1bf458b89d",
"resource": {
"resourceType": "Organization",
"id": "b125383d-223f-4c4e-b463-fb1bf458b89d",
"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/1486477c-e592-458f-8fd6-7ac1f7276e94",
"resource": {
"resourceType": "Coverage",
"id": "1486477c-e592-458f-8fd6-7ac1f7276e94",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "001044669891101"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/b102c4b0-f952-4ca3-b0a7-fd2c18eb9029"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/7c480960-bb1f-4552-9623-c8c228915f6a"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/29576bc3-41c7-433e-8ce8-72171b24d52a"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/b125383d-223f-4c4e-b463-fb1bf458b89d"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "52931859",
"name": "NATIONAL GRAIN SUPPLY COMPANY"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/b102c4b0-f952-4ca3-b0a7-fd2c18eb9029",
"resource": {
"resourceType": "Organization",
"id": "b102c4b0-f952-4ca3-b0a7-fd2c18eb9029",
"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/7c480960-bb1f-4552-9623-c8c228915f6a",
"resource": {
"resourceType": "Patient",
"id": "7c480960-bb1f-4552-9623-c8c228915f6a",
"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": "2125637708"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "KARIMAH SAFAR abdasis abdasis",
"given": [
"KARIMAH",
"abdasis",
"abdasis"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0551770632"
}
],
"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": "1988-01-09",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/8c2c1290-8ea6-419c-9621-4911b731314e",
"resource": {
"resourceType": "Bundle",
"id": "8c2c1290-8ea6-419c-9621-4911b731314e",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:52:16.843\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/6172aff6-da8a-412c-a5ac-ab74946a08d7",
"resource": {
"resourceType": "MessageHeader",
"id": "6172aff6-da8a-412c-a5ac-ab74946a08d7",
"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": "0e8dfc6f-b394-41a3-a313-f3fb66d11e2d",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/01400345-90bb-4a77-bd20-058241e0fd98"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/01400345-90bb-4a77-bd20-058241e0fd98",
"resource": {
"resourceType": "ClaimResponse",
"id": "01400345-90bb-4a77-bd20-058241e0fd98",
"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": "2106"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "01400345-90bb-4a77-bd20-058241e0fd98"
}
],
"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/f4fc4eb9-f901-462a-9334-64369d7b8ca9"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/ed01a7e8-36df-4dd5-a8d9-76091f82a8fb"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/3376285b-a7a2-4732-942e-d1190bbd058a"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "53277945260924"
}
},
"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": "97543"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "AD-2-4"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 7.02,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.4,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 7.02,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
"code": "approved-quantity"
}
]
},
"value": 0
}
]
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
"code": "approved"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "97543"
}
}
],
"itemSequence": 2,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 24.97,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 4.99,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 24.97,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 19.98,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
"code": "approved-quantity"
}
]
},
"value": 1
}
]
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
"code": "rejected"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "97543"
}
}
],
"itemSequence": 3,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 8.19,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "AD-2-4"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 1.64,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 8.19,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
"code": "approved-quantity"
}
]
},
"value": 0
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 40.18,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 19.98,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 8.03,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 40.18,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
}
],
"insurance": [
{
"sequence": 1,
"focal": true,
"coverage": {
"reference": "https://tawuniya.com.sa/Coverage/ddb6232e-de76-4db4-9e25-d1eee54e1b6e"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/f4fc4eb9-f901-462a-9334-64369d7b8ca9",
"resource": {
"resourceType": "Patient",
"id": "f4fc4eb9-f901-462a-9334-64369d7b8ca9",
"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": "2009364833"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "ROQAYAAH hagi HAMZAH",
"given": [
"ROQAYAAH",
"hagi",
"HAMZAH"
]
}
],
"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": "1982-10-11",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/3376285b-a7a2-4732-942e-d1190bbd058a",
"resource": {
"resourceType": "Organization",
"id": "3376285b-a7a2-4732-942e-d1190bbd058a",
"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/ed01a7e8-36df-4dd5-a8d9-76091f82a8fb",
"resource": {
"resourceType": "Organization",
"id": "ed01a7e8-36df-4dd5-a8d9-76091f82a8fb",
"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/ddb6232e-de76-4db4-9e25-d1eee54e1b6e",
"resource": {
"resourceType": "Coverage",
"id": "ddb6232e-de76-4db4-9e25-d1eee54e1b6e",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002014659342101"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/9629538a-ff4b-4aea-97ff-00bbf674eaf1"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/9a396284-b0ef-4447-b67e-43831a691056"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/f4fc4eb9-f901-462a-9334-64369d7b8ca9"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/ed01a7e8-36df-4dd5-a8d9-76091f82a8fb"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "54832259",
"name": "Jabal Albena contrac Basic"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/9629538a-ff4b-4aea-97ff-00bbf674eaf1",
"resource": {
"resourceType": "Organization",
"id": "9629538a-ff4b-4aea-97ff-00bbf674eaf1",
"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/9a396284-b0ef-4447-b67e-43831a691056",
"resource": {
"resourceType": "Patient",
"id": "9a396284-b0ef-4447-b67e-43831a691056",
"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": "2009364833"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "ROQAYAAH hagi HAMZAH",
"given": [
"ROQAYAAH",
"hagi",
"HAMZAH"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0536553468"
}
],
"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": "1982-10-11",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/cf31bef3-1d36-4581-ac69-499404688e28",
"resource": {
"resourceType": "Bundle",
"id": "cf31bef3-1d36-4581-ac69-499404688e28",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:52:16.843\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/caadd7be-1d38-46fb-8293-bf58d97c4d9d",
"resource": {
"resourceType": "MessageHeader",
"id": "caadd7be-1d38-46fb-8293-bf58d97c4d9d",
"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": "d0a09d14-d5a5-4d2d-a6fc-61a46ee2202d",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/23a55835-8ce2-485a-b434-ed3f4efa4b18"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/23a55835-8ce2-485a-b434-ed3f4efa4b18",
"resource": {
"resourceType": "ClaimResponse",
"id": "23a55835-8ce2-485a-b434-ed3f4efa4b18",
"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": "1702"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "23a55835-8ce2-485a-b434-ed3f4efa4b18"
}
],
"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/83b901ab-ae6c-43c8-a479-9a537665fc42"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/657cca5a-1ae4-402d-bbef-79525c469c39"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/83f0409e-435a-477b-bbbb-d1bbc8e2b66f"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "43267036260920"
}
},
"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": "93430"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 10.3,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 10.3,
"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": 10.3,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
"code": "approved-quantity"
}
]
},
"value": 1
}
]
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
"code": "approved"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "93430"
}
}
],
"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": 4.95,
"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": "submitted"
}
]
},
"amount": {
"value": 7.42,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 7.42,
"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": 17.72,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 15.25,
"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": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 17.72,
"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/7e534e93-d40a-4770-a6ad-078ce2a2899a"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/83b901ab-ae6c-43c8-a479-9a537665fc42",
"resource": {
"resourceType": "Patient",
"id": "83b901ab-ae6c-43c8-a479-9a537665fc42",
"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": "2490742943"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "AHMED salman ALANSARY",
"given": [
"AHMED",
"salman",
"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": "2019-11-13",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/83f0409e-435a-477b-bbbb-d1bbc8e2b66f",
"resource": {
"resourceType": "Organization",
"id": "83f0409e-435a-477b-bbbb-d1bbc8e2b66f",
"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/657cca5a-1ae4-402d-bbef-79525c469c39",
"resource": {
"resourceType": "Organization",
"id": "657cca5a-1ae4-402d-bbef-79525c469c39",
"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/7e534e93-d40a-4770-a6ad-078ce2a2899a",
"resource": {
"resourceType": "Coverage",
"id": "7e534e93-d40a-4770-a6ad-078ce2a2899a",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002004884207221"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/b279f27d-24a1-4bd8-ac43-5e46b7db13cf"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/e0de862d-f4a8-4885-84ee-ca09ceca2767"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/83b901ab-ae6c-43c8-a479-9a537665fc42"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/657cca5a-1ae4-402d-bbef-79525c469c39"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "8400",
"name": "Ahed Business Services Company"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/b279f27d-24a1-4bd8-ac43-5e46b7db13cf",
"resource": {
"resourceType": "Organization",
"id": "b279f27d-24a1-4bd8-ac43-5e46b7db13cf",
"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/e0de862d-f4a8-4885-84ee-ca09ceca2767",
"resource": {
"resourceType": "Patient",
"id": "e0de862d-f4a8-4885-84ee-ca09ceca2767",
"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": "2490742943"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "AHMED salman ALANSARY",
"given": [
"AHMED",
"salman",
"ALANSARY"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0553024310"
}
],
"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": "2019-11-13",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/0c02aa48-be37-4de2-b0ed-b731c46d0389",
"resource": {
"resourceType": "Bundle",
"id": "0c02aa48-be37-4de2-b0ed-b731c46d0389",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:53:23.438\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/0422b361-40f1-4d7b-b93d-aab18d6fe8e4",
"resource": {
"resourceType": "MessageHeader",
"id": "0422b361-40f1-4d7b-b93d-aab18d6fe8e4",
"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": "a526f1a0-b012-4b26-8fda-90c96aa56fc8",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/c03808f1-21ea-436f-af16-892888a3aeed"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/c03808f1-21ea-436f-af16-892888a3aeed",
"resource": {
"resourceType": "ClaimResponse",
"id": "c03808f1-21ea-436f-af16-892888a3aeed",
"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": "1518"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "c03808f1-21ea-436f-af16-892888a3aeed"
}
],
"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/caea72ee-158e-4883-b750-2c63be3ad8a3"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/858103a9-c26c-48ab-a895-2248dc0ae462"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/e063d652-a9b8-4652-89aa-f07e5eea25f0"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "71261885260919"
}
},
"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": "91427"
}
}
],
"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"
}
]
},
"amount": {
"value": 40.14,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "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": 1
}
]
}
],
"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": 40.14,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 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/fc93abf5-22b7-43ce-b01f-9aaa0daee5b1"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/caea72ee-158e-4883-b750-2c63be3ad8a3",
"resource": {
"resourceType": "Patient",
"id": "caea72ee-158e-4883-b750-2c63be3ad8a3",
"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": "1137334288"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "MAIS osama manshy",
"given": [
"MAIS",
"osama",
"manshy"
]
}
],
"gender": "female",
"_gender": {
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code": "female",
"display": "female"
}
]
}
}
]
},
"birthDate": "2007-02-15",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/e063d652-a9b8-4652-89aa-f07e5eea25f0",
"resource": {
"resourceType": "Organization",
"id": "e063d652-a9b8-4652-89aa-f07e5eea25f0",
"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/858103a9-c26c-48ab-a895-2248dc0ae462",
"resource": {
"resourceType": "Organization",
"id": "858103a9-c26c-48ab-a895-2248dc0ae462",
"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/fc93abf5-22b7-43ce-b01f-9aaa0daee5b1",
"resource": {
"resourceType": "Coverage",
"id": "fc93abf5-22b7-43ce-b01f-9aaa0daee5b1",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "001069713145211"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/3f3f3f9e-1893-4f37-a271-812df16ef428"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/2710401a-0203-4ab8-9706-a701fcb86fa8"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/caea72ee-158e-4883-b750-2c63be3ad8a3"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/858103a9-c26c-48ab-a895-2248dc0ae462"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "49137093",
"name": "MAKKAH CONSTRUCTION COMPANY"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/3f3f3f9e-1893-4f37-a271-812df16ef428",
"resource": {
"resourceType": "Organization",
"id": "3f3f3f9e-1893-4f37-a271-812df16ef428",
"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/2710401a-0203-4ab8-9706-a701fcb86fa8",
"resource": {
"resourceType": "Patient",
"id": "2710401a-0203-4ab8-9706-a701fcb86fa8",
"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": "1137334288"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "MAIS osama manshy",
"given": [
"MAIS",
"osama",
"manshy"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0555065409"
}
],
"gender": "female",
"_gender": {
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code": "female",
"display": "female"
}
]
}
}
]
},
"birthDate": "2007-02-15",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/29c0caba-1e8e-40df-bae2-c41e55458898",
"resource": {
"resourceType": "Bundle",
"id": "29c0caba-1e8e-40df-bae2-c41e55458898",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:53:23.778\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/571f75ff-929f-49b4-b7b6-b12b39850a21",
"resource": {
"resourceType": "MessageHeader",
"id": "571f75ff-929f-49b4-b7b6-b12b39850a21",
"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": "1a08ebbc-e9fd-423c-b419-571930757bb1",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/d4ee3322-afc5-45bd-ba31-cc0f36569960"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/d4ee3322-afc5-45bd-ba31-cc0f36569960",
"resource": {
"resourceType": "ClaimResponse",
"id": "d4ee3322-afc5-45bd-ba31-cc0f36569960",
"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": "828"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "d4ee3322-afc5-45bd-ba31-cc0f36569960"
}
],
"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/0c8723a0-5e15-4844-8a93-ad37837c0f27"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/7587fdaf-3529-4267-8deb-69690e90a416"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/0ee94c2b-885f-458e-a461-d7e03f597a35"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "22242602260910"
}
},
"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": "83879"
}
}
],
"itemSequence": 1,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 18,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 22.5,
"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": 22.5,
"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": 4.5,
"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": "83879"
}
}
],
"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": 28.85,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 22.54,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 5.63,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 28.85,
"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/1d574280-8006-4d83-a53b-892a60bb1e12"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/0c8723a0-5e15-4844-8a93-ad37837c0f27",
"resource": {
"resourceType": "Patient",
"id": "0c8723a0-5e15-4844-8a93-ad37837c0f27",
"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": "2577868546"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "AHMED ABDULMAJID ali ALI",
"given": [
"AHMED",
"ali",
"ALI"
]
}
],
"gender": "male",
"_gender": {
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code": "male",
"display": "male"
}
]
}
}
]
},
"birthDate": "1997-04-05",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "U"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/0ee94c2b-885f-458e-a461-d7e03f597a35",
"resource": {
"resourceType": "Organization",
"id": "0ee94c2b-885f-458e-a461-d7e03f597a35",
"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/7587fdaf-3529-4267-8deb-69690e90a416",
"resource": {
"resourceType": "Organization",
"id": "7587fdaf-3529-4267-8deb-69690e90a416",
"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/1d574280-8006-4d83-a53b-892a60bb1e12",
"resource": {
"resourceType": "Coverage",
"id": "1d574280-8006-4d83-a53b-892a60bb1e12",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002577868546001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/586373d9-a6e8-42e9-8930-21380e56faab"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/43355d99-9894-4b66-9108-daeb759ff68d"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/0c8723a0-5e15-4844-8a93-ad37837c0f27"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/7587fdaf-3529-4267-8deb-69690e90a416"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "53384398",
"name": "AlFikr AlSaid Contra Bronze B"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/586373d9-a6e8-42e9-8930-21380e56faab",
"resource": {
"resourceType": "Organization",
"id": "586373d9-a6e8-42e9-8930-21380e56faab",
"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/43355d99-9894-4b66-9108-daeb759ff68d",
"resource": {
"resourceType": "Patient",
"id": "43355d99-9894-4b66-9108-daeb759ff68d",
"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": "2577868546"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "AHMED ABDULMAJID ali ALI",
"given": [
"AHMED",
"ali",
"ALI"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0565489921"
}
],
"gender": "male",
"_gender": {
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender",
"code": "male",
"display": "male"
}
]
}
}
]
},
"birthDate": "1997-04-05",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/04a9a059-bd17-4f33-b79c-99a1e20260ec",
"resource": {
"resourceType": "Bundle",
"id": "04a9a059-bd17-4f33-b79c-99a1e20260ec",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:53:23.488\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/242336aa-16a1-46b0-894d-2a1ec6246bc4",
"resource": {
"resourceType": "MessageHeader",
"id": "242336aa-16a1-46b0-894d-2a1ec6246bc4",
"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": "2471c334-9666-423c-ba51-9b49f3c37f64",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/6aecd976-65af-4589-960e-72b6d617e8d1"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/6aecd976-65af-4589-960e-72b6d617e8d1",
"resource": {
"resourceType": "ClaimResponse",
"id": "6aecd976-65af-4589-960e-72b6d617e8d1",
"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": "423"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "6aecd976-65af-4589-960e-72b6d617e8d1"
}
],
"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/0c2c7cdf-5ed0-4273-87b3-b6e076d35927"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/e9be69fe-7e72-433a-bea0-58a670f0bea4"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/fb5cd9e1-afe3-42fa-b00c-ab8f0faf8513"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "23231803260906"
}
},
"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": "79636"
}
}
],
"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-4-5"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 67.05,
"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": 13.41,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 67.05,
"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": "79636"
}
}
],
"itemSequence": 2,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 17.46,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 3.49,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 17.46,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 13.97,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
"code": "approved-quantity"
}
]
},
"value": 1
}
]
},
{
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome",
"code": "rejected"
}
]
}
},
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice",
"valueIdentifier": {
"system": "http://www.ALKholood.com/patientInvoice",
"value": "79636"
}
}
],
"itemSequence": 3,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 18.9,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "MN-1-1"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 9.45,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 18.9,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication",
"code": "approved-quantity"
}
]
},
"value": 0
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 103.41,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"amount": {
"value": 13.97,
"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": 26.35,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 103.41,
"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/ce8dfc23-7669-4a46-aaf8-bb96d5d151f2"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/0c2c7cdf-5ed0-4273-87b3-b6e076d35927",
"resource": {
"resourceType": "Patient",
"id": "0c2c7cdf-5ed0-4273-87b3-b6e076d35927",
"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": "2087354573"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "RABA THAHER GRAR GRAR",
"given": [
"RABA",
"GRAR",
"GRAR"
]
}
],
"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": "1992-01-01",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/fb5cd9e1-afe3-42fa-b00c-ab8f0faf8513",
"resource": {
"resourceType": "Organization",
"id": "fb5cd9e1-afe3-42fa-b00c-ab8f0faf8513",
"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/e9be69fe-7e72-433a-bea0-58a670f0bea4",
"resource": {
"resourceType": "Organization",
"id": "e9be69fe-7e72-433a-bea0-58a670f0bea4",
"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/ce8dfc23-7669-4a46-aaf8-bb96d5d151f2",
"resource": {
"resourceType": "Coverage",
"id": "ce8dfc23-7669-4a46-aaf8-bb96d5d151f2",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002081025690101"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/75e87b05-7986-4ea0-858c-002718a79fa4"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/dc05f127-2cd2-4e31-8d13-50fd298286aa"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/0c2c7cdf-5ed0-4273-87b3-b6e076d35927"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/e9be69fe-7e72-433a-bea0-58a670f0bea4"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "52875197",
"name": "ALASEFAH CO Bronze B"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/75e87b05-7986-4ea0-858c-002718a79fa4",
"resource": {
"resourceType": "Organization",
"id": "75e87b05-7986-4ea0-858c-002718a79fa4",
"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/dc05f127-2cd2-4e31-8d13-50fd298286aa",
"resource": {
"resourceType": "Patient",
"id": "dc05f127-2cd2-4e31-8d13-50fd298286aa",
"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": "2087354573"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "RABA THAHER GRAR GRAR",
"given": [
"RABA",
"GRAR",
"GRAR"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0551571005"
}
],
"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": "1992-01-01",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://nphies.sa/Bundle/b72d3723-c2ce-41dd-a078-5809185f0fcf",
"resource": {
"resourceType": "Bundle",
"id": "b72d3723-c2ce-41dd-a078-5809185f0fcf",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0"
]
},
"type": "message",
"timestamp": "2026-10-20T11:53:23.621\u002B03:00",
"entry": [
{
"fullUrl": "https://tawuniya.com.sa/MessageHeader/c91a747d-f486-49ae-bd03-3a438d4de1dc",
"resource": {
"resourceType": "MessageHeader",
"id": "c91a747d-f486-49ae-bd03-3a438d4de1dc",
"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": "93ae26fb-035b-4697-92b3-54acd6591a8d",
"code": "ok"
},
"focus": [
{
"reference": "https://tawuniya.com.sa/ClaimResponse/37b4f5be-c9a4-40f2-951b-93cff20d32f4"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/ClaimResponse/37b4f5be-c9a4-40f2-951b-93cff20d32f4",
"resource": {
"resourceType": "ClaimResponse",
"id": "37b4f5be-c9a4-40f2-951b-93cff20d32f4",
"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": "2057"
}
}
],
"identifier": [
{
"system": "https://tawuniya.com.sa/claimResponse",
"value": "37b4f5be-c9a4-40f2-951b-93cff20d32f4"
}
],
"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/8aa7389e-0bb2-4de5-b1c2-25374035a393"
},
"created": "2026-10-20",
"insurer": {
"reference": "https://tawuniya.com.sa/Organization/805cef7b-84b0-430b-bccb-198a24be88a6"
},
"requestor": {
"reference": "https://tawuniya.com.sa/Organization/ad8c3970-39d3-4d52-9a51-8a6f7a18c199"
},
"request": {
"identifier": {
"system": "http://www.ALKholood.com/claim",
"value": "58276701260924"
}
},
"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": "97113"
}
}
],
"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": "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": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
]
},
"amount": {
"value": 2.22,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 11.11,
"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": "97113"
}
}
],
"itemSequence": 2,
"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": "copay"
}
]
},
"amount": {
"value": 8.15,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 40.77,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "MN-1-1"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "tax"
}
]
},
"amount": {
"value": 0,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://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": "97113"
}
}
],
"itemSequence": 3,
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
]
},
"amount": {
"value": 5.8,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "benefit"
}
]
},
"reason": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason",
"code": "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": "copay"
}
]
},
"amount": {
"value": 1.16,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 5.8,
"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": 57.68,
"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": 11.53,
"currency": "SAR"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
]
},
"amount": {
"value": 57.68,
"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/ebf27098-ff34-4b6f-a1fa-f0b6fa4d1f26"
}
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Patient/8aa7389e-0bb2-4de5-b1c2-25374035a393",
"resource": {
"resourceType": "Patient",
"id": "8aa7389e-0bb2-4de5-b1c2-25374035a393",
"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": "2061945982"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "gader shaikh ALI",
"given": [
"gader",
"shaikh",
"ALI"
]
}
],
"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": "1967-01-01",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/ad8c3970-39d3-4d52-9a51-8a6f7a18c199",
"resource": {
"resourceType": "Organization",
"id": "ad8c3970-39d3-4d52-9a51-8a6f7a18c199",
"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/805cef7b-84b0-430b-bccb-198a24be88a6",
"resource": {
"resourceType": "Organization",
"id": "805cef7b-84b0-430b-bccb-198a24be88a6",
"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/ebf27098-ff34-4b6f-a1fa-f0b6fa4d1f26",
"resource": {
"resourceType": "Coverage",
"id": "ebf27098-ff34-4b6f-a1fa-f0b6fa4d1f26",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0"
]
},
"identifier": [
{
"system": "https://tawuniya.com.sa/memberid",
"value": "002061945982001"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/coverage-type",
"code": "EHCPOL"
}
]
},
"policyHolder": {
"reference": "https://tawuniya.com.sa/Organization/7556cf6c-37e5-4b95-a2fb-a6fe918568a8"
},
"subscriber": {
"reference": "https://tawuniya.com.sa/Patient/65a82eda-b6ab-424b-8cdf-a6fde1856219"
},
"beneficiary": {
"reference": "https://tawuniya.com.sa/Patient/8aa7389e-0bb2-4de5-b1c2-25374035a393"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self",
"display": "self"
}
]
},
"payor": [
{
"reference": "https://tawuniya.com.sa/Organization/805cef7b-84b0-430b-bccb-198a24be88a6"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "58317979",
"name": "ABDULLAH FOUAD COMPANY LTD"
}
]
}
},
{
"fullUrl": "https://tawuniya.com.sa/Organization/7556cf6c-37e5-4b95-a2fb-a6fe918568a8",
"resource": {
"resourceType": "Organization",
"id": "7556cf6c-37e5-4b95-a2fb-a6fe918568a8",
"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/65a82eda-b6ab-424b-8cdf-a6fde1856219",
"resource": {
"resourceType": "Patient",
"id": "65a82eda-b6ab-424b-8cdf-a6fde1856219",
"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": "2061945982"
}
],
"active": true,
"name": [
{
"use": "official",
"text": "gader shaikh ALI",
"given": [
"gader",
"shaikh",
"ALI"
]
}
],
"telecom": [
{
"system": "phone",
"value": "0508670518"
}
],
"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": "1967-01-01",
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "M"
}
]
}
}
}
]
}
},
{
"fullUrl": "http://www.ALKholood.com/Organization/9",
"resource": {
"resourceType": "Organization",
"id": "9",
"meta": {
"profile": [
"http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0"
]
},
"extension": [
{
"url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type",
"valueCodeableConcept": {
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/provider-type",
"code": "5",
"display": "Clinic"
}
]
}
}
],
"identifier": [
{
"use": "official",
"system": "http://nphies.sa/license/provider-license",
"value": "10000300062591"
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "http://nphies.sa/terminology/CodeSystem/organization-type",
"code": "prov"
}
]
}
],
"name": "Al-Kholood Medical Company - AlHaj"
}
}
]
}
No stored-procedure executions recorded
Either the poll failed before reaching the database, or SQL capture
is switched off in the Diagnostics configuration section.