<?xml version="1.0" encoding="UTF-8" standalone="yes"?>
<RootData>
<Claim>
        <TypeOfService>PC</TypeOfService>
        <ServiceTypeCde>S</ServiceTypeCde>
        <ExtServicingDoctor>123456AF</ExtServicingDoctor>
        <Voucher>
            <ExternalPatientId>EPatId003</ExternalPatientId>
            <ExternalInvoice>EInv003</ExternalInvoice>
            <PatientFamilyName>Simpson</PatientFamilyName>
            <PatientFirstName>Bart</PatientFirstName>
            <PatientDateOfBirth>12/06/1957</PatientDateOfBirth>
            <PatientMedicareCardNum>2111-11111-1</PatientMedicareCardNum>
            <PatientReferenceNum>1</PatientReferenceNum>
            <ReferringProviderNum>1234567K</ReferringProviderNum>
            <ReferralIssueDate>01/07/2023</ReferralIssueDate>
            <ReferralPeriod>12</ReferralPeriod>
            <RefDrFirstName>Paul</RefDrFirstName>
            <RefDrLastName>Walker</RefDrLastName>
            <RefDrTitle>Dr</RefDrTitle>
            <BankAccountName></BankAccountName>
            <BankAccountNum></BankAccountNum>
            <BSBCode></BSBCode>
            <ClaimantAddressLine1>123 Test St</ClaimantAddressLine1>
			<ClaimantAddressLine2>Tester</ClaimantAddressLine2>
            <ClaimantAddressLocality>Darlington</ClaimantAddressLocality>
            <ClaimantAddressPostcode>1234</ClaimantAddressPostcode>
            <ClaimantDateOfBirth>01/01/1990</ClaimantDateOfBirth>
			<ClaimantAddressState>NSW</ClaimantAddressState>
			<ClaimantPhone>0412345678</ClaimantPhone>
            <ClaimantFamilyName>John</ClaimantFamilyName>
            <ClaimantFirstName>Smith</ClaimantFirstName>
            <ClaimantMedicareCardNum>2111-11111-1</ClaimantMedicareCardNum>
            <ClaimantReferenceNum>1</ClaimantReferenceNum>
            <DateOfService>01/07/2023</DateOfService>
			<TimeOfService>1400</TimeOfService>			
            <FeeList>3</FeeList>
            <ClaimSubmissionAuthorised>Y</ClaimSubmissionAuthorised>
            <NumberItems>1</NumberItems>
            <Service>
                  <ChargeAmount>100.00</ChargeAmount>
                  <ItemNum>36</ItemNum>
                  <ServiceText></ServiceText>
                  <PaidAmount>100.00</PaidAmount>
            </Service>
        </Voucher>
    </Claim>
</RootData>
