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GS*HS*RP016*RP016*260818*1108*1487113239*X*005010X279A1~
ST*270*000050057*005010X279A1~
BHT*0022*13*000050057*2608230*1108~
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*COGLIANO*JOSEPH****MI*9999999~
DMG*D8*19550824*M~
DTP*291*RD8*20260818-20261116~
EQ*42~
EQ*30~
SE*14*000050057~
GE*1*50057~
IEA*1*000050057~