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ST*270*000034381*005010X279A1~
BHT*0022*13*000034381*2511311*1311~
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*SCHMIDT*SANFORD****MI*381153186~
DMG*D8*19470927*M~
DTP*291*RD8*20251107-20260205~
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IEA*1*000034381~