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GS*HS*600118*600118*250811*1208*1073904009*X*005010X279A1~
ST*270*000000368*005010X279A1~
BHT*0022*13*000000368*2508223*1208~
HL*1**20*1~
NM1*PR*2*AETNA*****PI*10011~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*SCHAPPI*ANN****MI*W141446928~
DMG*D8*19600910*F~
DTP*291*RD8*20250811-20251109~
EQ*42~
EQ*30~
SE*14*000000368~
GE*1*368~
IEA*1*000000368~