ISA*00*          *00*          *ZZ*12345          *ZZ*12345          *250918*1209*^*00501*000004872*0*P*>~
GS*HS*12345*12345*250918*1209*1234567891*X*005010X279A1~
ST*270*000004872*005010X279A1~
BHT*0022*13*000004872*2509261*1209~
HL*1**20*1~
NM1*PR*2*MEDICARE ARIZONA*****PI*00832~
HL*2*1*21*1~
NM1*1P*2*HOME HEALTH CARES*****XX*1234567891~
HL*3*2*22*0~
NM1*IL*1*ABBOTT*ANNIE****MI*3XW6DX4CG47~
DMG*D8*19520215*F~
DTP*291*RD8*20250918-20251217~
EQ*42~
EQ*30~
SE*14*000004872~
GE*1*4872~
IEA*1*000004872~