CHA-JOS-65

Code
CHA-JOS-65
Mercy ID
V-00702-01
Encounter Date
10/03/2001
Last
Chavez
First
Josefina
DOB
02/20/1965
County
Clayton
Street
8988 Dorsy Road
City
Riverdale
State
GA
Zip
30274-
Home
(404) 435-4147
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school
Home Owner
YES

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
YES
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. Perez
Data Entry
K. Aleman