ISA*00*          *00*          *ZZ*1059619        *ZZ*263086998      *250808*1708*^*00501*000000133*0*P*>~
GS*HS*263086998*263086998*250808*1708*1356449631*X*005010X279A1~
ST*270*000000133*005010X279A1~
BHT*0022*13*000000133*2508220*1708~
HL*1**20*1~
NM1*PR*2*MEDICAID ADULT LTC*****PI*12K03~
HL*2*1*21*1~
NM1*1P*2*DELTA HEALTH HOME HEALTH*****XX*1356449631~
HL*3*2*22*0~
NM1*IL*1*BEYETTE*DIANE****MI*Y122509~
DMG*D8*19570817*F~
DTP*291*RD8*20250808-20251106~
EQ*42~
EQ*30~
SE*14*000000133~
GE*1*133~
IEA*1*000000133~