MOR-JUD-65

Code
MOR-JUD-65
Mercy ID
V-00722-01
Encounter Date
10/24/2001
Last
Mora mendoza
First
Judith
DOB
03/12/1965
County
Dekalb
Street
Chamblee Hights
City
Chamblee
State
GA
Zip
00000-0000
Home
(000) 000-0000
Cell
(000) 000-0000
Family Status
Single adult
COB
Puerto Rico
Gender
Female
Housing
Street
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. Manzo
Data Entry
K. Aleman