ISA*00*          *00*          *ZZ*00             *ZZ*               *070709*1507*U*00401**0*P*>~
GS*HC**C00380*070709*1507*6*X*004010X096A1~
ST*837*000000001*~
BHT*0019*00*000001*070709*1507*CH~
REF*87*004010X096A1~
NM1*41*2*Port HomeCare Services, INC*****46**~
PER*IC*Linda Poling*TE*3616435059~
NM1*40*2*Medicare*****46*C00380~
HL*1**20*1~
NM1*85*2*Port HomeCare Services, INC*****24*~
N3*315 Fifth Ave~
N4*Portland*TX*78374~
REF*1C*459268~
PER*IC*Linda Poling*TE*3616435059~
HL*2*1*22*0~SBR*P*18**UNKNOWN*****MA~
NM1*IL*1*Wooldridge*Margaret****MI*453035994A~
N3*1461 Ormond~
N4*Corpus Christi*TX*78415*~
DMG*D8*19160810*F~
NM1*PR*2*Medicare*****PI*C00380~
N3*2300 Springdale Drive*P.O. Box 7004~
N4*Camden*SC*29021-7004~
CLM*Wooldridge Margaret:09/05/2007*000***32>A>2*Y**Y*Y*********Y~
DTP*434*RD8*20070709-20070709~
DTP*435*DT*20070510~
CL1**1*30 Still patient or expected to return for outpatient services~
REF*G1*051020070705200704~
HI*BK>4280*~
HI*BF>30000*
HI*BF>2865*
HI*BF>42731*
HI*BF>4280*
HI*BF>56400*
HI*BF>2865*
HI*BF>4139*
HI*BF>42731*
HI*BF>2865*
HI*BF>4019*
HI*BF>30000*
~HI*BE>61>>>18580~ 
NM1*71*1*Neff*Michael J.****24*112112112~
REF*1G*C19815~
LX*1~
SV2*0023*ZZ>HCGJ1*0*UN*4~
DTP*472*D8*20070709~
SE*40*000000001~
GE*85*6~
IEA*1*459268~