ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251217*0712*^*00501*000001249*0*P*>~
GS*HS*52095*52095*251217*0712*1073904009*X*005010X279A1~
ST*270*000001249*005010X279A1~
BHT*0022*13*000001249*2512351*0712~
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*COLE*DANIELLE****MI*18270364~
DMG*D8*19730902*F~
DTP*291*RD8*20251217-20260317~
EQ*42~
EQ*30~
SE*14*000001249~
GE*1*1249~
IEA*1*000001249~