ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *260713*1107*^*00501*000002552*0*P*>~
GS*HS*15004*15004*260713*1107*1073904009*X*005010X279A1~
ST*270*000002552*005010X279A1~
BHT*0022*13*000002552*2607194*1107~
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*WONG*VIMOLPORN****MI*5DP3GN4KG75~
DMG*D8*19520708*F~
DTP*291*RD8*20260713-20261011~
EQ*42~
EQ*30~
SE*14*000002552~
GE*1*2552~
IEA*1*000002552~

