ISA*00*          *00*          *ZZ*10353          *ZZ*10353          *251107*1511*^*00501*000000687*0*P*>~
GS*HS*10353*10353*251107*1511*1073904009*X*005010X279A1~
ST*270*000000687*005010X279A1~
BHT*0022*13*000000687*2511311*1511~
HL*1**20*1~
NM1*PR*2*HUMANA GOLD CHOICE*****PI*6013~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*ODUM*SHIRLEY****MI*H71902417~
DMG*D8*19380729*F~
DTP*291*RD8*20251107-20260205~
EQ*42~
EQ*30~
SE*14*000000687~
GE*1*687~
IEA*1*000000687~