ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251111*1511*^*00501*000000961*0*P*>~
GS*HS*52095*52095*251111*1511*1073904009*X*005010X279A1~
ST*270*000000961*005010X279A1~
BHT*0022*13*000000961*2511315*1511~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*DUONG*HAU****MI*19217261~
DMG*D8*20251111*M~
DTP*291*RD8*20251111-20260209~
EQ*42~
EQ*30~
SE*14*000000961~
GE*1*961~
IEA*1*000000961~

