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GS*HS*12345*12345*250903*1509*1073904009*X*005010X279A1~
ST*270*000000531*005010X279A1~
BHT*0022*13*000000531*2509246*1509~
HL*1**20*1~
NM1*PR*2*UNITED HEALTH CARE MCR ADVANTAGE*****PI*10784~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*IQBAL*ZAFAR****MI*13286510701~
DMG*D8*19480810*M~
DTP*291*RD8*20250903-20251202~
EQ*42~
EQ*30~
SE*14*000000531~
GE*1*531~
IEA*1*000000531~

