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GS*HS*52095*52095*260628*1606*1073904009*X*005010X279A1~
ST*270*000002526*005010X279A1~
BHT*0022*13*000002526*2606179*1606~
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*SOTELO PARADA*LUIS****MI*89287948~
DMG*D8*19570517*M~
DTP*291*RD8*20260628-20260926~
EQ*42~
EQ*30~
SE*14*000002526~
GE*1*2526~
IEA*1*000002526~

