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GS*HS*52095*52095*250813*1408*1487113239*X*005010X279A1~
ST*270*000030820*005010X279A1~
BHT*0022*13*000030820*2508225*1408~
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*HARGROVE*COREY****MI*68155331~
DMG*D8*19691128*M~
DTP*291*RD8*20250813-20251111~
EQ*42~
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IEA*1*000030820~