ISA*00*          *00*          *ZZ*77027          *ZZ*TRADEPARTNERID *080205*1318*U*00401*000011208*0*T*:
GS*RA*77027*TRADEPARTNERID*20080205*1318*11208*X*004010X061A1
ST*820*0001
BPR*I*123*C*FWT************20080128
TRN*3*61111
REF*14*1234567899
DTM*582****RD8*20070301-20070331
N1*PE*RECEIVERNAME*FI*122233333
N1*PR*STATE OF FLORIDA MEDICAID*FI*593340183
ENT*1*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN****N*9998887777
RMR*AZ*8501234567**3
DTM*582****RD8*20070301-20070331
ADX*3*53
ENT*2*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*L***N*9998887777
RMR*AZ*8501234567**3*1
DTM*582****RD8*20070301-20070331
ADX*2*53
ENT*3*2J*ZZ*1255896124
NM1*QE*1*RECIPLNAME*RECIPFN****N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*4*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*D***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*5*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*T***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*6*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*N***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*7*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*D***N*9998887777
RMR*AZ*138609170**3*3
DTM*582****RD8*20070301-20070331
ENT*8*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN****N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*9*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*I***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*10*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*I***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*11*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*S***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*12*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*N***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*13*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN****N*9998887777
RMR*AZ*138609180**3*3
DTM*582****RD8*20070301-20070331
ENT*14*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN****N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*15*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN****N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*16*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*M***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*17*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*V***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*18*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*L***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*19*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*F***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*20*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*F***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*21*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*R***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*22*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*J***N*9998887777
RMR*AZ*138609190**3*3
DTM*582****RD8*20070301-20070331
ENT*23*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*S***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*24*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*E***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*25*2J*ZZ*030030030'
NM1*QE*1*RECIPLNAME*RECIPFN*E***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*26*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*E***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*27*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*L***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*28*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN****N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*29*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN****N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*30*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN****N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*31*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*M***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*32*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*D***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*33*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN****N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*34*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN****N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*35*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*D***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*36*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*D***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*37*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*J***N*9998887777
RMR*AZ*138609209**3*3
DTM*582****RD8*20070301-20070331
ENT*38*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*J***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*39*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN****N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*40*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN****N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
ENT*41*2J*ZZ*030030030
NM1*QE*1*RECIPLNAME*RECIPFN*D***N*9998887777
RMR*AZ*8501234567**3*3
DTM*582****RD8*20070301-20070331
SE*174*0001
GE*1*11208
IEA*1*000011208