ISA*00*          *00*          *ZZ*               *ZZ*               *251120*1611*^*00501*000001043*0*P*>~
GS*HS***251120*1611*1073904009*X*005010X279A1~
ST*270*000001043*005010X279A1~
BHT*0022*13*000001043*2511324*1611~
HL*1**20*1~
NM1*PR*2*BCBS CAREFIRST*****PI*600110~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*HOHENTHANER*DIANN****MI*R50084316~
DMG*D8*19610222*F~
DTP*291*RD8*20251120-20260218~
EQ*42~
EQ*30~
SE*14*000001043~
GE*1*1043~
IEA*1*000001043~