ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251208*1512*^*00501*000027040*0*P*>~
GS*HS*52095*52095*251208*1512*1487113239*X*005010X279A1~
ST*270*000027040*005010X279A1~
BHT*0022*13*000027040*2512342*1512~
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*ROBERTS*CAROL****MI*641088609~
DMG*D8*19351229*F~
DTP*291*RD8*20251208-20260308~
EQ*42~
EQ*30~
SE*14*000027040~
GE*1*27040~
IEA*1*000027040~