ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *251214*1112*^*00501*000001226*0*P*>~
GS*HS*52095*52095*251214*1112*1073904009*X*005010X279A1~
ST*270*000001226*005010X279A1~
BHT*0022*13*000001226*2512348*1112~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE MEDICARE ADVANTAGE 1*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*CAMPBELL*ROMEO****MI*01087675~
DMG*D8*19531128*M~
DTP*291*RD8*20251214-20260314~
EQ*42~
EQ*30~
SE*14*000001226~
GE*1*1226~
IEA*1*000001226~