AYA-SER-70

Code
AYA-SER-70
Mercy ID
V-01036-02
Encounter Date
11/19/2002
Last
Ayala
First
Sergio
DOB
03/21/1970
County
Fulton
Street
2700 Buford Hwy Apt 27
City
Atlanta
State
GA
Zip
30342-
Home
(678) 886-1945
Family Status
Two parent family w/children
COB
Guatemala
Gender
Male
Housing
Doubling Up
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
No
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
R. Miranda
Data Entry
K. Aleman