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GS*HC*203793927*133052274*20190507*1714*3749*X*005010X222A1~
ST*837*0001*005010X222A1~
BHT*0019*00*3749*20190507*1714*CH~
NM1*41*2*Basking Ridge Group Home*****46*sub246~
PER*IC*Basking Ridge Group Home*TE*4052864817~
NM1*40*2*THCIC*****46*YTH837~
HL*1**20*1~
PRV*BI*PXC*261QA0600X~
NM1*85*2*MATHENY SCHOOL & HOSPITAL*****XX*1720585987~
N3*MAIN STREET PO BOX 339*~
N4*PEAPACK*NJ*07977~
REF*EI*221482276~
REF*0B*0582603~
PER*IC*Basking Ridge Group Home*TE*4052864817~
NM1*87*2~
N3*MAIN STREET PO BOX 339*~
N4*PEAPACK*NJ*07977~
HL*2*1*22*~
SBR*P*18*******MC~
NM1*IL*1*Chapin*Cheryl****MI*902003256501~
N3*33 North Maple Avenue~
N4*BASKING RIDGE*NJ*07920~
DMG*D8*19570824*F~
NM1*PR*2*MOLINA-G*****PI*SKNJ0~
N3*Po Box 4802~
N4*Trenton*NJ*08650~
CLM*15117G1849*1450.92***11>B>1*Y*A*Y*Y~
DTP*431*D8*19570824~
REF*G1*1550147099~
HI*ABK>G800 *ABF>E119 *ABF>I10 *ABF>Z853~
NM1*DN*1*BARBA*VINCENT****XX*1134139876~
REF*1D*7804008~
NM1*77*2*Basking Ridge Group Home*****XX*1497137087~
N3*33 North Maple Avenue*~
N4*BASKING RIDGE*NJ*07920~
REF*0B*0582603~
NM1*82*1*MATHENY*HOSPITAL****XX*1720585987~
REF*1D*0582603~
LX*1~
SV1*HC>H2016>HI>UR*241.82*UN*1*99**1**~
DTP*472*RD8*20181204-20181204~
REF*6R*1~
LX*2~
SV1*HC>H2016>HI>UR*241.82*UN*1*99**1**~
DTP*472*RD8*20181205-20181205~
REF*6R*2~
LX*3~
SV1*HC>H2016>HI>UR*241.82*UN*1*99**1**~
DTP*472*RD8*20181206-20181206~
REF*6R*3~
LX*4~
SV1*HC>H2016>HI>UR*241.82*UN*1*99**1**~
DTP*472*RD8*20181207-20181207~
REF*6R*4~
LX*5~
SV1*HC>H2016>HI>UR*241.82*UN*1*99**1**~
DTP*472*RD8*20181208-20181208~
REF*6R*5~
LX*6~
SV1*HC>H2016>HI>UR*241.82*UN*1*99**1**~
DTP*472*RD8*20181209-20181209~
REF*6R*6~
SE*62*0001~
GE*1*3749~
IEA*1*000003749~