ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260921*1409*^*00501*000051096*0*P*>~
GS*HS*52095*52095*260921*1409*1487113239*X*005010X279A1~
ST*270*000051096*005010X279A1~
BHT*0022*13*000051096*2609264*1409~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE ADVANTAGE - PT SAFETY ASSESSMENT*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*ALFORD*EDWARD****MI*59179279~
DMG*D8*19460927*M~
DTP*291*RD8*20260921-20261220~
EQ*42~
EQ*30~
SE*14*000051096~
GE*1*51096~
IEA*1*000051096~