ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *260203*1902*^*00501*000001504*0*P*>~
GS*HS*52095*52095*260203*1902*1073904009*X*005010X279A1~
ST*270*000001504*005010X279A1~
BHT*0022*13*000001504*260234*1902~
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*HERNANDEZ DE*ANGELICA****MI*791288981~
DMG*D8*19480627*M~
DTP*291*RD8*20260203-20260504~
EQ*42~
EQ*30~
SE*14*000001504~
GE*1*1504~
IEA*1*000001504~

