ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *260511*1005*^*00501*000001958*0*P*>~
GS*HS*15004*15004*260511*1005*1073904009*X*005010X279A1~
ST*270*000001958*005010X279A1~
BHT*0022*13*000001958*2605131*1005~
HL*1**20*1~
NM1*PR*2*MEDICARE PPS*****PI*10000~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*SHEFTEL*RAMONA****MI*3GW3EP6GY75~
DMG*D8*19420406*F~
DTP*291*RD8*20260511-20260809~
EQ*42~
EQ*30~
SE*14*000001958~
GE*1*1958~
IEA*1*000001958~