ASC-LOR-74

Code
ASC-LOR-74
Mercy ID
V-00541-01
Encounter Date
01/08/2002
Last
Ascencio curiel
First
Guadalupe lorena
DOB
12/12/1974
County
Other
Street
6904 Roswell Rd. 7-B
City
Atlanta
State
GA
Zip
30328-
Home
(999) 999-9999
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high school
Home Owner
No

Parents Information

Name DOB COB
Mother N/A N/A N/A
Father N/A N/A N/A
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Does not want us to contact her.
Lives With
N/A
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
No
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
J. Manzo
Data Entry
K. Aleman