ISA*00*          *00*          *ZZ*               *ZZ*               *260814*1008*^*00501*000002678*0*P*>~
GS*HS***260814*1008*1073904009*X*005010X279A1~
ST*270*000002678*005010X279A1~
BHT*0022*13*000002678*2608226*1008~
HL*1**20*1~
NM1*PR*2*ANTHEM BCBS*****PI*600113~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*KICIELINSKI*TADAS****MI*C9X179W25540~
DMG*D8*19740501*M~
DTP*291*RD8*20260814-20261112~
EQ*42~
EQ*30~
SE*14*000002678~
GE*1*2678~
IEA*1*000002678~