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GS*HS*12345*12345*251006*1710*1073904009*X*005010X279A1~
ST*270*000000411*005010X279A1~
BHT*0022*13*000000411*2510279*1710~
HL*1**20*1~
NM1*PR*2*UNITED HEALTH CARE MCR ADVANTAGE*****PI*10784~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*ALTIZER*JANIS****MI*126386138~
DMG*D8*19450417*F~
DTP*291*RD8*20251006-20260104~
EQ*42~
EQ*30~
SE*14*000000411~
GE*1*411~
IEA*1*000000411~

