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GS*HS*0000*0000*251003*1310*1073904009*X*005010X279A1~
ST*270*000000662*005010X279A1~
BHT*0022*13*000000662*2510276*1310~
HL*1**20*1~
NM1*PR*2*CIGNA PPO POS OPEN ACCESS*****PI*10158~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*ELNAGGAR-LASHEEN*HANAA****MI*U4310136301~
DMG*D8*19580901*F~
DTP*291*RD8*20251003-20260101~
EQ*42~
EQ*30~
SE*14*000000662~
GE*1*662~
IEA*1*000000662~