MEN-ROS-63

Code
MEN-ROS-63
Mercy ID
V-00567-01
Encounter Date
06/27/2001
Last
Mena
First
Rosa
DOB
02/17/1963
County
Dekalb
Street
963 Park Gate Pl.
City
Stone mountain
State
GA
Zip
30083-
Home
(404) 297-3565
Family Status
Single parent w/children
COB
Colombia
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
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