ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *260203*1502*^*00501*000001274*0*P*>~
GS*HS*15004*15004*260203*1502*1073904009*X*005010X279A1~
ST*270*000001274*005010X279A1~
BHT*0022*13*000001274*260234*1502~
HL*1**20*1~
NM1*PR*2*MEDICARE PPS*****PI*10000~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*HILL*DONNIE****MI*4X00Y94TG04~
DMG*D8*19351030*F~
DTP*291*RD8*20260203-20260504~
EQ*42~
EQ*30~
SE*14*000001274~
GE*1*1274~
IEA*1*000001274~