SHA-NAH-05

Code
SHA-NAH-05
Mercy ID
V-01181-11
Encounter Date
05/02/2007
Last
Shamon
First
Nahreen
DOB
09/11/2005
County
Dekalb
Street
3317 Church St.
City
Clarkston
State
GA
Zip
30021-
Home
(404) 508-1422
Cell
(678) 787-9697
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Doubling Up
Education Level
Preschool
Home Owner
YES

Parents Information

Name DOB COB
Mother Gabriela Ayala 11/20/1970 Mexico
Father Marveen Shamon 02/22/1973 Irak
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Hiperactividad
Lives With
Parents
Name of School
Headstart
Grade
Pre-K
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
YES
Authoritation Child
No
DOY PERMISO
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
Volunteer
Data Entry
J. Manzo