MON-IRM-71

Code
MON-IRM-71
Mercy ID
V-01015-01
Encounter Date
10/03/2002
Last
Monje
First
Irma
DOB
03/17/1971
County
Dekalb
Street
Peachtree Ind. Blv. 101
City
Doraville
State
GA
Zip
30360-
Home
(404) 396-8849
Cell
(404) 934-2512
Family Status
Single parent w/children
COB
Guatemala
Gender
Female
Housing
Not Homeless
Education Level
Grade 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