ISA*00*          *00*          *ZZ*12345          *ZZ*12345          *260922*1309*^*00501*000002770*0*P*>~
GS*HS*12345*12345*260922*1309*1073904009*X*005010X279A1~
ST*270*000002770*005010X279A1~
BHT*0022*13*000002770*2609265*1309~
HL*1**20*1~
NM1*PR*2*UNITED HEALTH CARE MCR ADVANTAGE*****PI*10784~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*NGUYEN*KHUC****MI*126549757~
DMG*D8*19430323*F~
DTP*291*RD8*20260922-20261221~
EQ*42~
EQ*30~
SE*14*000002770~
GE*1*2770~
IEA*1*000002770~

