GIL-AMA-75

Code
GIL-AMA-75
Mercy ID
V-01730-01
Encounter Date
10/15/2004
Last
Gildo
First
Amalia
DOB
03/27/1975
County
Gwinnett
Street
204 Treehouse Parkway
City
Norcross
State
GA
Zip
30093-
Home
(770) 939-1901
Cell
(678) 923-2002
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
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