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GS*HS*52095*52095*250807*1708*1487113239*X*005010X279A1~
ST*270*000029766*005010X279A1~
BHT*0022*13*000029766*2508219*1708~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE ADVANTAGE - PT SAFETY ASSESSMENT*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*DURBIN*LINDA****MI*94180772~
DMG*D8*19501020*F~
DTP*291*RD8*20250807-20251105~
EQ*42~
EQ*30~
SE*14*000029766~
GE*1*29766~
IEA*1*000029766~