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GS*HS*52095*52095*260128*0801*1487113239*X*005010X279A1~
ST*270*000039429*005010X279A1~
BHT*0022*13*000039429*260128*0801~
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*NWANNA*VINCENT****MI*391292164~
DMG*D8*19490511*M~
DTP*291*RD8*20260128-20260428~
EQ*42~
EQ*30~
SE*14*000039429~
GE*1*39429~
IEA*1*000039429~