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GS*HS*52095*52095*250813*1308*1487113239*X*005010X279A1~
ST*270*000030812*005010X279A1~
BHT*0022*13*000030812*2508225*1308~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE COMMERCIAL - 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*REVELLE*KATHLEEN****MI*46311009~
DMG*D8*19610825*F~
DTP*291*RD8*20250813-20251111~
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IEA*1*000030812~