ESP-YAD-05

Code
ESP-YAD-05
Mercy ID
V-01734-14
Encounter Date
06/15/2005
Last
Esparza
First
Yadira
DOB
05/08/2005
County
Cobb
Street
2640 Burrell Court
City
Kenessaw
State
GA
Zip
30144-
Home
(770) 562-4065
Family Status
Attached youth
COB
Mexico
Gender
Female Child
Housing
Not Homeless
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Natividad Guzman 12/14/1975 Mexico
Father Ramon Esparza N/A Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother
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
Y. Garcia
Data Entry
K. Aleman