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GS*HS***251209*1612*1073904009*X*005010X279A1~
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BHT*0022*13*000001118*2512343*1612~
HL*1**20*1~
NM1*PR*2*UNITED HEALTH CARE - PUBLIC SECTOR VA*****PI*600086~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*PERKINS*LAWERENCE****MI*05107654500~
DMG*D8*19760709*M~
DTP*291*RD8*20251209-20260309~
EQ*42~
EQ*30~
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GE*1*1118~
IEA*1*000001118~