DOL-LES-58

Code
DOL-LES-58
Mercy ID
V-01543-01
Encounter Date
03/25/2004
Last
Dollan
First
Lesly
DOB
11/02/1958
County
Cobb
Street
3670 Lakewood Ct
City
Marietta
State
GA
Zip
30066-
Home
(678) 978-4100
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Other
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
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