ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *260605*1706*^*00501*000002376*0*P*>~
GS*HS*52095*52095*260605*1706*1073904009*X*005010X279A1~
ST*270*000002376*005010X279A1~
BHT*0022*13*000002376*2606156*1706~
HL*1**20*1~
NM1*PR*2*KAISER MEDICAID*****PI*52095~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*KRARSSI*LAILA****MI*58345414~
DMG*D8*19660622*F~
DTP*291*RD8*20260605-20260903~
EQ*42~
EQ*30~
SE*14*000002376~
GE*1*2376~
IEA*1*000002376~

