ISA*00*          *00*          *ZZ*12345          *ZZ*12345          *260501*1305*^*00501*000006354*0*P*>~
GS*HS*12345*12345*260501*1305*1234567891*X*005010X279A1~
ST*270*000006354*005010X279A1~
BHT*0022*13*000006354*2605121*1305~
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*JOHNSON*MARTIN****MI*1234567~
DMG*D8*19650921*M~
DTP*291*RD8*20260501-20260730~
EQ*42~
EQ*30~
SE*14*000006354~
GE*1*6354~
IEA*1*000006354~