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GS*HS*10353*10353*260408*1604*1073904009*X*005010X279A1~
ST*270*000002022*005010X279A1~
BHT*0022*13*000002022*260498*1604~
HL*1**20*1~
NM1*PR*2*HUMANA GOLD CHOICE*****PI*6013~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*HOROSKO*MICHELE****MI*H76903490~
DMG*D8*19490920*F~
DTP*291*RD8*20260408-20260707~
EQ*42~
EQ*30~
SE*14*000002022~
GE*1*2022~
IEA*1*000002022~