ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *260202*1402*^*00501*000001556*0*P*>~
GS*HS*52095*52095*260202*1402*1073904009*X*005010X279A1~
ST*270*000001556*005010X279A1~
BHT*0022*13*000001556*260233*1402~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE ADVANTAGE - PT SAFETY ASSESSMENT*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*BIRCKHEAD*NORMA****MI*261087510~
DMG*D8*19501018*F~
DTP*291*RD8*20260202-20260503~
EQ*42~
EQ*30~
SE*14*000001556~
GE*1*1556~
IEA*1*000001556~

