ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *260106*1301*^*00501*000001241*0*P*>~
GS*HS*52095*52095*260106*1301*1073904009*X*005010X279A1~
ST*270*000001241*005010X279A1~
BHT*0022*13*000001241*260106*1301~
HL*1**20*1~
NM1*PR*2*KAISER MEDICAID*****PI*52095~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*BEGUM*MOSAMMAT****MI*74249974~
DMG*D8*19721112*F~
DTP*291*RD8*20260106-20260406~
EQ*42~
EQ*30~
SE*14*000001241~
GE*1*1241~
IEA*1*000001241~