ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *251103*1411*^*00501*000000845*0*P*>~
GS*HS*52095*52095*251103*1411*1073904009*X*005010X279A1~
ST*270*000000845*005010X279A1~
BHT*0022*13*000000845*2511307*1411~
HL*1**20*1~
NM1*PR*2*KAISER MEDICAID*****PI*52095~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*ALAKHDAR*ASMAA****MI*13319965~
DMG*D8*19880909*F~
DTP*291*RD8*20251103-20260201~
EQ*42~
EQ*30~
SE*14*000000845~
GE*1*845~
IEA*1*000000845~