ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *251001*0910*^*00501*000000625*0*P*>~
GS*HS*52095*52095*251001*0910*1073904009*X*005010X279A1~
ST*270*000000625*005010X279A1~
BHT*0022*13*000000625*2510274*0910~
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*WILD*SUSAN****MI*17245360~
DMG*D8*19490521*F~
DTP*291*RD8*20251001-20251230~
EQ*42~
EQ*30~
SE*14*000000625~
GE*1*625~
IEA*1*000000625~

