ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *251105*1611*^*00501*000000853*0*P*>~
GS*HS*52095*52095*251105*1611*1073904009*X*005010X279A1~
ST*270*000000853*005010X279A1~
BHT*0022*13*000000853*2511309*1611~
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*MASRI-IMADI*FETNAT****MI*311070719~
DMG*D8*19560106*F~
DTP*291*RD8*20251105-20260203~
EQ*42~
EQ*30~
SE*14*000000853~
GE*1*853~
IEA*1*000000853~