BLA-MIR-74

Code
BLA-MIR-74
Mercy ID
V-00835-01
Encounter Date
02/11/2002
Last
Blancas
First
Mirza
DOB
07/30/1974
County
Dekalb
Street
2204 Plaster Rd. Apt. H
City
Atlanta
State
GA
Zip
30345-
Home
(404) 808-0696
Family Status
Single adult
COB
Perú
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
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