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GS*HS*52095*52095*260619*1006*1073904009*X*005010X279A1~
ST*270*000002491*005010X279A1~
BHT*0022*13*000002491*2606170*1006~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*BEATTY*SHANE****MI*87243681~
DMG*D8*19770108*M~
DTP*291*RD8*20260619-20260917~
EQ*42~
EQ*30~
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IEA*1*000002491~