ISA*00* *00* *ZZ*77027 *ZZ*PLAN ID *110703*0219*^*00501*104094254*0*T*:~ GS*BE*77027*PLAN ID*20110703*0219*104094254*X*005010X220A1~ ST*834*0001*005010X220A1~ BGN*00*1*20110702*222017****2~ REF*38*PLAN ID~ DTP*007*D8*20110629~ QTY*TO*5~ N1*P5*STATE OF FLORIDA MEDICAID*FI*593452939~ N1*IN**FI*PLAN TAX ID~ INS*Y*18*001*22*A***FT**N~ REF*0F*MEMBER ID~ REF*1L*PLAN TYPE~ REF*3H*CASE NUMBER~ REF*F6*HIC NUMBER~ DTP*356*D8*20110101~ DTP*474*D8*20111130~ NM1*IL*1*LAST NAME*FIRST NAME~ PER*IP**HP*8131234567*TE*8131234567~ N3*STREET ADDRESS~ N4*ZEPHYRHILLS*FL*335422776**CY*51~ DMG*D8*19810517*M**C~ LUI*LD*ENG~ NM1*31*1~ N3*STREET ADDRESS~ N4*ZEPHYRHILLS*FL*335422776~ NM1*QD*1*RESPONSIBLE PERSON LAST NAME*RESPONSIBLE PERSON FIRST NAME~ HD*001**HMO*12F6M ME IE8~ DTP*303*D8*20110722~ DTP*348*D8*20110101~ INS*Y*18*001*22*A***FT**N~ REF*0F*MEMBER ID~ REF*1L*PLAN TYPE~ REF*3H*CASE NUMBER~ REF*F6*HIC NUMBER~ DTP*356*D8*20110501~ DTP*474*D8*20110831~ NM1*IL*1*LAST NAME*FIRST NAME~ PER*IP**HP*8137827399*TE*8137672951~ N3*STREET ADDRESS~ N4*ZEPHYRHILLS*FL*335416911**CY*51~ DMG*D8*19710105*F**C~ LUI*LD*ENG~ NM1*31*1~ N3*STREET ADDRESS~ N4*ZEPHYRHILLS*FL*335416911~ NM1*QD*1*RESPONSIBLE PERSON LAST NAME*RESPONSIBLE PERSON FIRST NAME~ HD*001**HMO*12F6F ME CE1~ DTP*303*D8*20110722~ DTP*348*D8*20110501~ INS*Y*18*001*22*A***FT**N~ REF*0F*MEMBER ID~ REF*1L*PLAN TYPE~ REF*3H*CASE NUMBER~ DTP*356*D8*20100901~ DTP*474*D8*20111031~ NM1*IL*1*LAST NAME*FIRST NAME~ PER*IP**HP*8134120294~ N3*STREET ADDRESS~ N4*LAND O LAKES*FL*346392750**CY*51~ DMG*D8*19700827*F**E~ LUI*LD*ENG~ NM1*31*1~ N3*STREET ADDRESS~ N4*LAND O LAKES*FL*346392750~ NM1*QD*1*RESPONSIBLE PERSON LAST NAME*RESPONSIBLE PERSON FIRST NAME~ HD*001**HMO*12F6F ME IE8~ DTP*303*D8*20110722~ DTP*348*D8*20100901~ INS*Y*18*001*22*A***FT**N~ REF*0F*MEMBER ID~ REF*1L*PLAN TYPE~ REF*3H*CASE NUMBER~ DTP*356*D8*20110101~ DTP*474*D8*20120131~ NM1*IL*1*LAST NAME*FIRST NAME~ PER*IP**HP*7276431691~ N3*STREET ADDRESS~ N4*NEW PORT RICHEY*FL*346543701**CY*51~ DMG*D8*19670519*F**C~ LUI*LD*ENG~ NM1*31*1~ N3*STREET ADDRESS~ N4*NEW PORT RICHEY*FL*346543701~ NM1*QD*1*RESPONSIBLE PERSON LAST NAME*RESPONSIBLE PERSON FIRST NAME~ HD*001**HMO*12F6F MA RE1~ DTP*303*D8*20110722~ DTP*348*D8*20110101~ LX*1~ NM1*P3*2******SV*111111100*72~ LX*2~ NM1*P3*2******XX*1234567890*72~ INS*Y*18*001*22*A***FT**N~ REF*0F*MEMBER ID~ REF*1L*PLAN TYPE~ REF*3H*CASE NUMBER~ DTP*356*D8*20101201~ DTP*474*D8*20110930~ NM1*IL*1*LAST NAME*FIRST NAME~ N3*STREET ADDRESS~ N4*DADE CITY*FL*335232173**CY*51~ DMG*D8*19650711*F**C~ LUI*LD*ENG~ NM1*31*1~ N3*STREET ADDRESS~ N4*DADE CITY*FL*335232173~ NM1*QD*1*RESPONSIBLE PERSON LAST NAME*RESPONSIBLE PERSON FIRST NAME~ HD*001**HMO*12F6F ME IE8~ DTP*303*D8*20110722~ DTP*348*D8*20101201~ SE*108*0001~ GE*1*104094254~ IEA*1*104094254~