Insured Demographics
P1:
  Name: Zachary T Lohrman
  Gender: Male
  DOB: 2000-08-30
P2:
  Name: Christopher L Zmuda
  Gender: Male
  DOB: 1991-10-19
Insurance Company: Camden County Healthcare
Ins ID: 619432
Group Number: 26526569
Patient: Zachary L

ISA*00*  *00*  *XX*RECEIVER       *ZZ*SENDER    *160407*0804*U*00401*000000001*0*T**
GS*HS*RECEIVER*TEST*20191209*0804*0001*X*004010X092A~
ST*270*1~
BHT*0022*13*1*20191209*0804~
HL*1~
NM1*PR*2*Camden County Healthcare*****PI*619432~
NM1*80*2*MIS MEDICAL GROUP*****XX*26526569~
TRN*001234~
NM1***LOHRMAN*ZACHARY****MI*T~
DMG*D8*20000830*M~
DTP*RD8**20191209-20191209~
EQ*30~
DTP*RD8**20191209-20191209~
TRN*001234~
NM1***ZMUDA*CHRISTOPHER****MI*L~
DMG*D8*19911019*M~
DTP*RD8**20191209-20191209~
EQ*30~
DTP*RD8**20191209-20191209~
SE*16*1~
GE*1*0001~
IEA*1*000000001~