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GS*HS*52095*52095*250801*1108*1487113239*X*005010X279A1~
ST*270*000025496*005010X279A1~
BHT*0022*13*000025496*2508213*1108~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*TERRY JR*GEORGE****MI*36110654~
DMG*D8*19610527*M~
DTP*291*RD8*20250801-20251030~
EQ*42~
EQ*30~
SE*14*000025496~
GE*1*25496~
IEA*1*000025496~