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GS*HS*52095*52095*250918*1409*1073904009*X*005010X279A1~
ST*270*000000126*005010X279A1~
BHT*0022*13*000000126*2509261*1409~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*JOHNSON*CATHERINE****MI*14114144~
DMG*D8*19500824*F~
DTP*291*RD8*20250918-20251217~
EQ*42~
EQ*30~
SE*14*000000126~
GE*1*126~
IEA*1*000000126~