MEN-MIR-72

Code
MEN-MIR-72
Mercy ID
V-01897-01
Encounter Date
04/19/2005
Last
Mena
First
Mirely
DOB
07/26/1972
County
Fulton
Street
3006 Delmar Lane NW # B-1
City
Atlanta
State
GA
Zip
30311-
Home
(404) 696-6733
Cell
(404) 822-4811
Family Status
Single parent w/children
COB
Honduras
Gender
Female
Housing
Doubling Up
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
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
G. Landeros
Data Entry
K. Aleman