ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *251110*1611*^*00501*000000957*0*P*>~
GS*HS*52095*52095*251110*1611*1073904009*X*005010X279A1~
ST*270*000000957*005010X279A1~
BHT*0022*13*000000957*2511314*1611~
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*IDRIS*ABDELKARIM****MI*698319960~
DMG*D8*19780811*M~
DTP*291*RD8*20251110-20260208~
EQ*42~
EQ*30~
SE*14*000000957~
GE*1*957~
IEA*1*000000957~