<eCLAIMS 
    pUserName=":DUMMYSWCERTID" 
    pUserPassword="" 
    pHospitalCode="111111" 
    pHospitalEmail="email@yahoo.com">
    <eTRANSMITTAL 
        pHospitalTransmittalNo="111111-20230711-1" 
        pTotalClaims="1">
        <CLAIM 
            pClaimNumber="111111-01-01-20211-1" 
            pTrackingNumber=""
            pPhilhealthClaimType="ALL-CASE-RATE"
            pPatientType="I"
            pIsEmergency="N">
            <CF1 pMemberPIN="10123456789"
                   pMemberLastName="SAMPLE LN"
                   pMemberFirstName="SAMPLE FN"
                   pMemberSuffix=""
                   pMemberMiddleName="SAMPLE MN"
                   pMemberBirthDate="03-30-1968"
                   pMemberShipType="G"
                   pMailingAddress="A"
                   pZipCode="1950"
                   pMemberSex="F"
                   pLandlineNo="6080043"
                   pMobileNo=""
                   pEmailAddress=""
                   pPatientIs="M"
                   pPatientPIN="10123456789"
                   pPatientLastName="SAMPLE LN"
                   pPatientFirstName="SAMPLE FN"
                   pPatientSuffix=""
                   pPatientMiddleName="SAMPLE MN"
                   pPatientBirthDate="03-30-1968"
                   pPatientSex="F"
                   pPEN=""
                   pEmployerName=""/>
            <CF2
                pPatientReferred="Y"
                pReferredIHCPAccreCode="H92007103"
                pAdmissionDate="01-01-2021" 
                pAdmissionTime="01:00:00PM" 
                pDischargeDate="01-05-2021"
                pDischargeTime="03:00:00PM"
                pDisposition="I"
                pExpiredDate=""
                pExpiredTime=""
                pReferralIHCPAccreCode=""
                pReferralReasons=""
                pAccommodationType="N">
                <DIAGNOSIS
                    pAdmissionDiagnosis="PNEUMONIA">
                    <DISCHARGE
                        pDischargeDiagnosis="END STAGE RENAL DISEASE">
                        <ICDCODE pICDCode="I50.0"/>
                        <RVSCODES
                            pRelatedProcedure="ENTEROLYSIS"
                            pRVSCode="44005"
                            pProcedureDate="08-26-2009" 
                            pLaterality="L"/>
                    </DISCHARGE>
                    <DISCHARGE
                        pDischargeDiagnosis="DENGUE">
                        <ICDCODE pICDCode="A90.0"/>
                    </DISCHARGE>
                </DIAGNOSIS>
                <SPECIAL>
                </SPECIAL>
                <PROFESSIONALS
                    pDoctorAccreCode="0505-0505050-5"
                    pDoctorLastName="HCP LN" 
                    pDoctorFirstName="HCP FN" 
                    pDoctorMiddleName="HCP MN" 
                    pDoctorSuffix=""
                    pWithCoPay="Y"
                    pDoctorCoPay="0"
                    pDoctorSignDate="05-25-2018" />
                <CONSUMPTION
                    pEnoughBenefits="Y">
                    <BENEFITS
                        pTotalHCIFees="1000"
                        pTotalProfFees="1000"
                        pGrandTotal="2000"/>
                </CONSUMPTION>
            </CF2>
            <ALLCASERATE>
                <CASERATE pCaseRateCode="CR0136"
                          pICDCode="I50.0"
                          pRVSCode=""
                          pCaseRateAmount="15700.00" />
            </ALLCASERATE>
            <PARTICULARS>
                <DRGMED 
                    pPurchaseDate="08-26-2009"
                    pDrugCode="X0001234" 
                    pPNDFCode="" 
                    pGenericName="PARACETAMOL" 
                    pBrandName="GAYAGESIC" 
                    pPreparation="TABLET 250MG" 
                    pQuantity="3"/>
                <DRGMED 
                    pPurchaseDate="08-26-2009"
                    pDrugCode="X0001235" 
                    pPNDFCode="" 
                    pGenericName="PARACETAMOL" 
                    pBrandName="GAYAGESIC" 
                    pPreparation="TABLET 250MG" 
                    pQuantity="3"/>
                <XLSO 
                    pDiagnosticDate="08-26-2009"
                    pDiagnosticType="IMAGING" 
                    pDiagnosticName="ULTRASOUND" 
                    pQuantity="2"/>
                <XLSO 
                    pDiagnosticDate="08-26-2009"
                    pDiagnosticType="IMAGING" 
                    pDiagnosticName="ULTRASOUND" 
                    pQuantity="2"/>
            </PARTICULARS>
            <RECEIPTS>
                <RECEIPT
                    pCompanyName="COMPANY"
                    pCompanyTIN="123-456-789"
                    pBIRPermitNumber="X1234546789"
                    pReceiptNumber="00001"
                    pReceiptDate="08-25-2009"
                    pVATExemptSale="0.00"
                    pVAT="12.00"
                    pTotal="100.00">    
                    <ITEM
                        pQuantity="10"
                        pUnitPrice="5"
                        pDescription="BIOGESIC"
                        pAmount="50.00"/>
                    <ITEM
                        pQuantity="5"
                        pUnitPrice="10"
                        pDescription="NEOZEP"
                        pAmount="50.00"/>
                </RECEIPT>
            </RECEIPTS>
            <DOCUMENTS>
                <DOCUMENT 
                    pDocumentType="CSF"
                    pDocumentURL="http://172.21.0.191:88/files/SAMPLE_CSF.pdf.enc"/>
				<DOCUMENT 
                    pDocumentType="ESA"
                    pDocumentURL="http://172.21.0.191:88/files/SAMPLE_ESOA.xml.enc"/>
            </DOCUMENTS>
        </CLAIM>
    </eTRANSMITTAL>
  </eCLAIMS>    

