| Patient | Anna Behrman | Preferred Language | Unspecified |
| Date of birth | October 13, 1965 | Sex | Female |
| Race | Unspecified
|
Ethnicity | Unspecified |
| Contact info | Home:
1730 N Clark St. Apt. 1507 Chicago, IL 60614, US Tel (Mobile): +1(312)-925-0020 Tel (Primary Home): +1(312)-925-0020 Mail: anna.behrman@comcast.net |
Patient IDs | 3040820 2.16.840.1.113883.3.3710.999.44.88800115636.7770000101
MM0000001109 2.16.840.1.113883.3.3710.3 MODMED 2.16.840.1.113883.3.3710.200.501 115636PAT000001119 2.16.840.1.113883.3.3710.200.500 |
| Document Id | test-id-254516232 2.16.840.1.113883.3.3710.0 |
| Document Created: | April 6, 2024, 08:44:03 +0000 |
| Performer | Karen Herbst | ||
| Author | Diana Tagaban, Total Lipedema Care - Arizona |
| Contact info | Work Place:
240 S La Cienega Blvd Ste 200 Beverly Hills, CA 902113324, US Tel (Work Place): 3108825454 |
| Encounter Id | 3901753 2.16.840.1.113883.3.3710.999.44.88800115636.7770000111 | ||
| Encounter Date | From November 30, 2023 | ||
| Encounter Participant | Karen Herbst | ||
| Contact info | Work Place:
6365 E Tanque Verde Road, Suite 200 Tucson, AZ 857153830, US Tel (Work Place): 3108825454 |
||
| Legal authenticator | Diana Tagaban signed at April 6, 2024, 08:44:03 +0000 |
| Contact info | Work Place:
240 S La Cienega Blvd Ste 200 Beverly Hills, CA 902113324, US Tel (Work Place): 3108825454 |
| Document maintained by | Total Lipedema Care - Arizona |
| Contact info | Work Place:
6365 E Tanque Verde Road, Suite 200 Tucson, AZ 857153830, US Tel (Work Place): 3108825454 |