MAT-AMA-77

Code
MAT-AMA-77
Mercy ID
V-01680-01
Encounter Date
08/16/2004
Last
Mata
First
Amalia
DOB
01/12/1977
County
Cobb
Street
6137 Nutmeg Ct.
City
Mableton
State
GA
Zip
30126-
Home
(770) 944-6122
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high 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
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