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GS*HS*52095*52095*260203*1502*1487113239*X*005010X279A1~
ST*270*000039127*005010X279A1~
BHT*0022*13*000039127*260234*1502~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*MINOR*STEFANIE****MI*67180393~
DMG*D8*19670420*F~
DTP*291*RD8*20260203-20260504~
EQ*42~
EQ*30~
SE*14*000039127~
GE*1*39127~
IEA*1*000039127~