ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *260504*1405*^*00501*000002202*0*P*>~
GS*HS*52095*52095*260504*1405*1073904009*X*005010X279A1~
ST*270*000002202*005010X279A1~
BHT*0022*13*000002202*2605124*1405~
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*MAUL*DONA****MI*66123538~
DMG*D8*19480413*F~
DTP*291*RD8*20260504-20260802~
EQ*42~
EQ*30~
SE*14*000002202~
GE*1*2202~
IEA*1*000002202~

