ISA*00*          *00*          *ZZ*12345          *ZZ*12345          *251212*1212*^*00501*000000799*0*P*>~
GS*HS*12345*12345*251212*1212*1073904009*X*005010X279A1~
ST*270*000000799*005010X279A1~
BHT*0022*13*000000799*2512346*1212~
HL*1**20*1~
NM1*PR*2*UNITED HEALTH CARE MCR ADVANTAGE*****PI*10784~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*PARK*CHARLES****MI*971471037~
DMG*D8*19310313*M~
DTP*291*RD8*20251212-20260312~
EQ*42~
EQ*30~
SE*14*000000799~
GE*1*799~
IEA*1*000000799~

