ISA*00*          *00*          *ZZ*12345          *ZZ*12345          *260508*1405*^*00501*000002218*0*P*>~
GS*HS*12345*12345*260508*1405*1073904009*X*005010X279A1~
ST*270*000002218*005010X279A1~
BHT*0022*13*000002218*2605128*1405~
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*AVERY*FREDERICK****MI*120259310~
DMG*D8*19500626*F~
DTP*291*RD8*20260508-20260806~
EQ*42~
EQ*30~
SE*14*000002218~
GE*1*2218~
IEA*1*000002218~

