ISA*00*          *00*          *ZZ*ME077187       *ZZ*14004          *250807*1608*^*00501*000000215*0*P*>~
GS*HS*14004*14004*250807*1608*1437179223*X*005010X279A1~
ST*270*000000215*005010X279A1~
BHT*0022*13*000000215*2508219*1608~
HL*1**20*1~
NM1*PR*2*MEDICARE*****PI*11001~
HL*2*1*21*1~
NM1*1P*2*BIENESTAR HOME HEALTH SERVICES*****XX*1437179223~
HL*3*2*22*0~
NM1*IL*1*SIKORSKI*JOANNA K****MI*6XX5D02CF51~
DMG*D8*19540801*F~
DTP*291*RD8*20250807-20251105~
EQ*42~
EQ*30~
SE*14*000000215~
GE*1*215~
IEA*1*000000215~