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GS*HS*52095*52095*250905*1609*1487113239*X*005010X279A1~
ST*270*000030026*005010X279A1~
BHT*0022*13*000030026*2509248*1609~
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*JOHNSON*DARRYL****MI*11203823~
DMG*D8*19610412*M~
DTP*291*RD8*20250905-20251204~
EQ*42~
EQ*30~
SE*14*000030026~
GE*1*30026~
IEA*1*000030026~