ISA*00*          *00*          *ZZ*00             *ZZ*               *070710*1007*U*00401**0*P*>~
GS*HC**C00380*070710*1007*6*X*004010X096A1~
ST*837*000000001*~
BHT*0019*00*000001*070710*1007*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*Gonzalez*Maria****MI*463482164D6~
N3*510 Dixon~
N4*Corpus Christi*TX*78412*~
DMG*D8*19400502*F~
NM1*PR*2*Medicare*****PI*C00380~
N3*2300 Springdale Drive*P.O. Box 7004~
N4*Camden*SC*29021-7004~
CLM*Gonzalez Maria:05/11/2007*000***32>A>9*Y**Y*Y*********Y~
DTP*434*RD8*20070313-20070511~
DTP*435*DT*20060716~
CL1**C*30 Still patient or expected to return for outpatient services~
REF*G1*071620060320200704~
HI*BK>5990*~
HI*BF>2829*
HI*BF>4019*
HI*BF>2394*
~HI*BE>61>>>18580~ 
NM1*71*1*Dickson*Efrain****24*112112112~
REF*1G*B22261~
LX*1~
SV2*0023*ZZ>HAFJ1*0*UN*4~
DTP*472*D8*20070313~
LX*1~
SV2*0551*HC>G0154*100*UN*4~
DTP*472*D8*20070313~
LX*2~
SV2*0551*HC>G0154*100*UN*4~
DTP*472*D8*20070404~
LX*3~
SV2*0551*HC>G0154*100*UN*4~
DTP*472*D8*20070412~
LX*4~
SV2*0551*HC>G0154*100*UN*4~
DTP*472*D8*20070426~
LX*5~
SV2*0551*HC>G0154*100*UN*4~
DTP*472*D8*20070510~
SE*40*000000001~
GE*85*6~
IEA*1*123456789~