ISA*00*          *00*          *ZZ*TAIGADEMO      *ZZ*CLINIC         *260922*1200*^*00501*000020265*0*T*:~
GS*HP*TAIGADEMO*CLINIC*20260922*1200*1*X*005010X221A1~
ST*835*0001~
BPR*I*130.68*C*CHK************20260922~
TRN*1*OHP-520265*11982744321~
DTM*405*20260922~
N1*PR*OREGON HEALTH PLAN~
N1*PE*TAIGA DEMO CLINIC*XX*1982744321~
LX*1~
CLP*VISIT-2026-2265*1*220.00*130.68*14.52*12*PCN-CLM-2265*11*1~
CAS*CO*45*74.80~
NM1*QC*1*FROST*SAMUEL~
SVC*HC:71046*220.00*130.68**1~
CAS*CO*45*74.80~
CAS*PR*3*14.52~
AMT*B6*145.20~
SE*15*0001~
GE*1*1~
IEA*1*000020265~