ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *260511*1205*^*00501*000001717*0*P*>~
GS*HS*52095*52095*260511*1205*1073904009*X*005010X279A1~
ST*270*000001717*005010X279A1~
BHT*0022*13*000001717*2605131*1205~
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*AMOS*ANN****MI*051047176~
DMG*D8*19361127*F~
DTP*291*RD8*20260511-20260809~
EQ*42~
EQ*30~
SE*14*000001717~
GE*1*1717~
IEA*1*000001717~

