ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *250917*1509*^*00501*000000579*0*P*>~
GS*HS*52095*52095*250917*1509*1073904009*X*005010X279A1~
ST*270*000000579*005010X279A1~
BHT*0022*13*000000579*2509260*1509~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE MEDICARE ADVANTAGE 1*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*UPDIKE*CHARLES****MI*32138018~
DMG*D8*19420914*M~
DTP*291*RD8*20250917-20251216~
EQ*42~
EQ*30~
SE*14*000000579~
GE*1*579~
IEA*1*000000579~

