ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *251023*1010*^*00501*000000788*0*P*>~
GS*HS*52095*52095*251023*1010*1073904009*X*005010X279A1~
ST*270*000000788*005010X279A1~
BHT*0022*13*000000788*2510296*1010~
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*NICHOLSON*LAWRENCE****MI*02209894~
DMG*D8*19511208*M~
DTP*291*RD8*20251023-20260121~
EQ*42~
EQ*30~
SE*14*000000788~
GE*1*788~
IEA*1*000000788~

