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GS*HS*RP016*RP016*260514*1705*1487113239*X*005010X279A1~
ST*270*000045923*005010X279A1~
BHT*0022*13*000045923*2605134*1705~
HL*1**20*1~
NM1*PR*2*ALTERWOOD HEALTH - EPISODIC*****PI*RP016~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*MITCHELL*JAMIS****MI*AA00017997~
DMG*D8*19510604*F~
DTP*291*RD8*20260514-20260812~
EQ*42~
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IEA*1*000045923~