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GS*HS*52095*52095*251015*1210*1487113239*X*005010X279A1~
ST*270*000034123*005010X279A1~
BHT*0022*13*000034123*2510288*1210~
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*CARR*STEPHANIE****MI*581012858~
DMG*D8*19581223*F~
DTP*291*RD8*20251015-20260113~
EQ*42~
EQ*30~
SE*14*000034123~
GE*1*34123~
IEA*1*000034123~