MAR-BLA-61

Code
MAR-BLA-61
Mercy ID
V-01109-01
Encounter Date
02/03/2003
Last
Martinez
First
Blanca leticia
DOB
06/01/1991
County
Dekalb
Street
2597 Pilgrim Way NE Apt E
City
Atlanta
State
GA
Zip
30345-
Home
(404) 358-3571
Family Status
Single parent w/children
COB
Honduras
Gender
Female
Housing
Doubling Up
Education Level
some high 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
DOB changed from recent intake on 10/1/04.
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