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GS*HS*52095*52095*260316*1303*1487113239*X*005010X279A1~
ST*270*000026335*005010X279A1~
BHT*0022*13*000026335*260375*1303~
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*SUMAN*MARY****MI*46173438~
DMG*D8*19470410*F~
DTP*291*RD8*20260316-20260614~
EQ*42~
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IEA*1*000026335~