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GS*HS*SKAZ0*SKAZ0*250806*0808*1457998957*X*005010X279A1~
ST*270*000000059*005010X279A1~
BHT*0022*13*000000059*2508218*0808~
HL*1**20*1~
NM1*PR*2*AHCCCS*****PI*SKAZ0~
HL*2*1*21*1~
NM1*1P*2*DEVOTION HOME HEALTH CARE, LLC*****XX*1457998957~
HL*3*2*22*0~
NM1*IL*1*GUTIERREZ*JASMINE****MI*N/a~
DMG*D8*19910914*F~
DTP*291*RD8*20250806-20251104~
EQ*42~
EQ*30~
SE*14*000000059~
GE*1*59~
IEA*1*000000059~