ISA*00*          *00*          *ZZ*12345          *ZZ*12345          *260410*0004*^*00501*000001904*0*P*>~
GS*HS*12345*12345*260410*0004*1073904009*X*005010X279A1~
ST*270*000001904*005010X279A1~
BHT*0022*13*000001904*2604100*0004~
HL*1**20*1~
NM1*PR*2*UNITED HEALTH CARE MCR ADVANTAGE*****PI*10784~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*MENDEZ UGARTE*DAISY****MI*123100882~
DMG*D8*19671001*F~
DTP*291*RD8*20260410-20260709~
EQ*42~
EQ*30~
SE*14*000001904~
GE*1*1904~
IEA*1*000001904~

