MED-ADR-96

Code
MED-ADR-96
Mercy ID
V-01099-21
Encounter Date
02/12/2003
Last
Medina
First
Adrian
DOB
08/10/1996
County
Gwinnett
Street
6533 Highland Dr. Apt. O
City
Norcross
State
GA
Zip
30092-
Home
(678) 571-0648
Family Status
Attached youth
COB
Mexico
Gender
Male Child
Housing
Not Homeless
Education Level
Grade school
Home Owner
YES

Parents Information

Name DOB COB
Mother Erika Adame 10/07/1973 Mexico
Father Ruben Medina 03/03/1968 Mexico
Step Parent Leonel Campusano 12/27/1975 Mexico
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother w/Stepfather
Name of School
Peachtree Elementary
Grade
1st.
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
Y. Garcia
Data Entry
K. Aleman