MED-MAR-71

Code
MED-MAR-71
Mercy ID
V-01895-01
Encounter Date
03/28/2005
Last
Medina
First
Marta
DOB
05/01/1971
County
Dekalb
Street
772 Jolly Ave. Apt J-3
City
Clarkston
State
GA
Zip
30021-
Home
(770) 912-0702
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade 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
No
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. Manzo
Data Entry
K. Aleman