ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *260623*1006*^*00501*000002508*0*P*>~
GS*HS*52095*52095*260623*1006*1073904009*X*005010X279A1~
ST*270*000002508*005010X279A1~
BHT*0022*13*000002508*2606174*1006~
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*OLSEN*PATRICIA****MI*56355899~
DMG*D8*19511015*F~
DTP*291*RD8*20260623-20260921~
EQ*42~
EQ*30~
SE*14*000002508~
GE*1*2508~
IEA*1*000002508~

