ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *260619*1306*^*00501*000002341*0*P*>~
GS*HS*15004*15004*260619*1306*1073904009*X*005010X279A1~
ST*270*000002341*005010X279A1~
BHT*0022*13*000002341*2606170*1306~
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*REMHOF*TARASIA****MI*6H81AQ2MQ10~
DMG*D8*19591109*F~
DTP*291*RD8*20260619-20260917~
EQ*42~
EQ*30~
SE*14*000002341~
GE*1*2341~
IEA*1*000002341~

