GOM-GRI-78

Code
GOM-GRI-78
Mercy ID
V-01158-01
Encounter Date
03/03/2003
Last
Gomez
First
Griselda
DOB
01/04/1978
County
Dekalb
Street
2139 Cosawaty Dr. Apt. G
City
Atlanta
State
GA
Zip
30319-
Home
(404) 325-8340
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school
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
J. Perez
Data Entry
K. Aleman