ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *260424*1004*^*00501*000002175*0*P*>~
GS*HS*52095*52095*260424*1004*1073904009*X*005010X279A1~
ST*270*000002175*005010X279A1~
BHT*0022*13*000002175*2604114*1004~
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*WEIS*STEPHANIE****MI*39217298~
DMG*D8*19510720*F~
DTP*291*RD8*20260424-20260723~
EQ*42~
EQ*30~
SE*14*000002175~
GE*1*2175~
IEA*1*000002175~