ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *251006*1410*^*00501*000000578*0*P*>~
GS*HS*15004*15004*251006*1410*1073904009*X*005010X279A1~
ST*270*000000578*005010X279A1~
BHT*0022*13*000000578*2510279*1410~
HL*1**20*1~
NM1*PR*2*MEDICARE PPS*****PI*10000~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*COLE*DUSTIN****MI*8F40U59VD15~
DMG*D8*19780609*M~
DTP*291*RD8*20251006-20260104~
EQ*42~
EQ*30~
SE*14*000000578~
GE*1*578~
IEA*1*000000578~