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*021*14*A***FT**N*D8*20110127~ REF*0F*MEMBER ID~ REF*1L*PLAN TYPE~ REF*3H*NO CASENUM~ REF*F6*HIC NUMBER~ DTP*356*D8*20110201~ NM1*IL*1*LAST NAME*FIRST NAME~ PER*IP**TE*7862355555~ N3*STREET ADDRESS~ N4*MIAMI*FL*331474209**CY*13~ DMG*D8*19520101*F**H~ LUI*LD*ENG~ NM1*QD*1*RESPONSIBLE PERSON LAST NAME*RESPONSIBLE PERSON FIRST NAME~ HD*021**AG~ DTP*348*D8*20110201~ INS*Y*18*025*28*A***FT**N~ REF*0F*MEMBER ID~ REF*1L*PLAN TYPE~ REF*3H*CASE NUMBER~ DTP*356*D8*20110301~ DTP*474*D8*20110731~ NM1*IL*1*LAST NAME*FIRST NAME~ N3*STREET ADDRESS~ N4*HIALEAH*FL*330188119**CY*13~ DMG*D8*19630403*F**H~ LUI*LD*SPA~ NM1*QD*1*RESPONSIBLE PERSON LAST NAME*RESPONSIBLE PERSON FIRST NAME~ HD*025**AG*16K9B MA RE4~ DTP*348*D8*20110301~ INS*Y*18*025*28*A***FT**N~ REF*0F*MEMBER ID~ REF*1L*PLAN TYPE~ REF*3H*CASE NUMBER~ DTP*356*D8*20110301~ DTP*474*D8*20110731~ NM1*IL*1*LAST NAME*FIRST NAME~ N3*STREET ADDRESS~ N4*HIALEAH*FL*330188119**CY*13~ DMG*D8*19930913*F**H~ LUI*LD*SPA~ NM1*QD*1*RESPONSIBLE PERSON LAST NAME*RESPONSIBLE PERSON FIRST NAME~ HD*025**AG*16K9B MA RE4~ DTP*348*D8*20110301~ INS*Y*18*025*28*A***FT**N~ REF*0F*MEMBER ID~ REF*1L*PLAN TYPE~ REF*3H*CASE NUMBER~ DTP*356*D8*20110401~ DTP*474*D8*20110731~ NM1*IL*1*LAST NAME*FIRST NAME~ N3*STREET ADDRESS~ N4*HIALEAH*FL*330188119**CY*13~ DMG*D8*19930913*F**H~ LUI*LD*SPA~ NM1*QD*1*RESPONSIBLE PERSON LAST NAME*RESPONSIBLE PERSON FIRST NAME~ HD*025**AG*16K9B MA RE4~ DTP*348*D8*20110401~ INS*Y*18*025*28*A***FT**N~ REF*0F*MEMBER ID~ REF*1L*PLAN TYPE~ REF*3H*CASE NUMBER~ DTP*356*D8*20110401~ DTP*474*D8*20110731~ NM1*IL*1*LAST NAME*FIRST NAME~ N3*STREET ADDRESS~ N4*CITY*FL*330188119**CY*13~ DMG*D8*19981119*F**H~ LUI*LD*SPA~ NM1*QD*1*RESPONSIBLE PERSON LAST NAME*RESPONSIBLE PERSON FIRST NAME~ HD*025**AG*16K9B MA RE4~ SE*77*0001~ GE*1*104094254~ IEA*1*104094254~