ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *260702*1307*^*00501*000002540*0*P*>~
GS*HS*15004*15004*260702*1307*1073904009*X*005010X279A1~
ST*270*000002540*005010X279A1~
BHT*0022*13*000002540*2607183*1307~
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*GEORGE*DONALD****MI*4DW0JH6MM15~
DMG*D8*19481115*M~
DTP*291*RD8*20260702-20260930~
EQ*42~
EQ*30~
SE*14*000002540~
GE*1*2540~
IEA*1*000002540~