Generated Narrative: ClaimResponse 142893

Adjudication Outcome: Approved

Advanced Auth Reason Extension: Medication dispense

Newborn: false

Service Provider Extension: Organization Saudi General Hospital

Diagnosis Extension

• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-sequence: 1
• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-diagnosisCodeableConcept: Obesity, not elsewhere classified, body mass index [BMI] >= 40 kg/m2
• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-diagnosis-type: Principal Diagnosis

Supporting Info Extension

• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-sequence: 1
• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-category: Days Supply
• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-valueQuantity: 7 d (Details: UCUM coded = 'd')

Supporting Info Extension

• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-sequence: 3
• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-category: chief complaint
• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-code: obesity with insulin resistence

Supporting Info Extension

• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-sequence: 2
• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-category: Attachment
• http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-supportingInfo-valueAttachment: image/jpeg: 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

identifier: http://sni.com.sa/identifiers/advanced-priorauth/417b345a-c829-4cdd-9a99-d95da2969449

status: Active

type: Pharmacy

subType: OutPatient

use: Preauthorization

patient: Ahmad Khaled Abbas(official) Male, DoB: 1984-12-25 ( Passport Number: G12345678)

created: 2022-09-15

insurer: Organization Saudi National Insurance

outcome: Processing Complete

preAuthRef: 23c6dc35-3b13-4837-be6a-fa68ed782a42

preAuthPeriod: 2022-09-15 18:10:44+0000 --> 2022-10-15 18:10:44+0000

addItem

Maternity: false

Adjudication Outcome: Approved

Sequence Extension: 1

Diagnosis Sequence Extension: 1

Information Sequence Extension: 1

Package Code: false

productOrService: Saxenda 6 MG/ML

quantity: 1

adjudication

category: Benefit Amount

Amounts

-	Value	Currency
*	100	Saudi riyal

adjudication

category: Approved Quantity

value: 1

total

category: Benefit Amount

Amounts

-	Value	Currency
*	100	Saudi riyal

Insurances