ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *260212*1402*^*00501*000001723*0*P*>~
GS*HS*52095*52095*260212*1402*1073904009*X*005010X279A1~
ST*270*000001723*005010X279A1~
BHT*0022*13*000001723*260243*1402~
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*MULLICK*NURUZZAMAN****MI*52285192~
DMG*D8*19771109*M~
DTP*291*RD8*20260212-20260513~
EQ*42~
EQ*30~
SE*14*000001723~
GE*1*1723~
IEA*1*000001723~

