MSH|^~\&|CHCS^ADT|N00183|DATAGATE|3M|20020628012707.0-0400||ADT^A31|R00183-241718545|P|2.3|
EVN|A31|20020628012707.0-0400|
PID|1||242366^^R00183|30/059-90-8525|fff^fff^fff||19610623000100.0-0400|F||C|3993 LOVE ARCH^^CALIFORNIA BEACH^VA^23456||7574718052|||M|CAT||954-15-7067|||OTH|||||4025^USN JAC MBR AD^^N41|
NK1|1|fff^fff|20^OTHER RELATIONSHIP|2904 CROSSTIE LANE^^CHESAPEAKE^VI^23323|7575581887|
PV1||O|
IN1|1||550^MEDICARE|MEDICARE|HCFA||||||healthcare financing adm|20000501000100.0-0400|20010501000100.0-0400|WE DO NOT BILL MEDICARE ....|MR|fff^fff^fff|02^HUSBAND||3993 jousting arch^^CALIFORNIA BEACH^^23456|||1||||||||||B||||254157067-a|
IN2|1|254-15-7067|