DOM-CON-75

Code
DOM-CON-75
Mercy ID
V-00974-01
Encounter Date
07/23/2002
Last
Dominguez
First
Consuelo
DOB
12/17/1975
County
Gwinnett
Street
228 Griffin St.
City
Lawrenceville
State
GA
Zip
30045-
Home
(770) 682-3130
Family Status
Single parent w/children
COB
Dominican Rep
Gender
Female
Housing
Other
Education Level
Some College
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