DOM-MAU-77

Code
DOM-MAU-77
Mercy ID
V-00763-01
Encounter Date
12/05/2001
Last
Dominguez
First
Maura
DOB
11/15/1977
County
Fulton
Street
261 Forest Park
City
Atlanta
State
GA
Zip
N/A
Home
(678) 985-1357
Family Status
Two parent family w/children
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
Grade 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
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