ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251201*1112*^*00501*000036440*0*P*>~
GS*HS*52095*52095*251201*1112*1487113239*X*005010X279A1~
ST*270*000036440*005010X279A1~
BHT*0022*13*000036440*2512335*1112~
HL*1**20*1~
NM1*PR*2*KAISER MEDICAID*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*HANRATTY*LAUREN****MI*16244808~
DMG*D8*19901103*F~
DTP*291*RD8*20251201-20260301~
EQ*42~
EQ*30~
SE*14*000036440~
GE*1*36440~
IEA*1*000036440~