MAR-FER-02

Code
MAR-FER-02
Mercy ID
V-01918-11
Encounter Date
07/06/2005
Last
Martinez
First
Fernanda
DOB
05/19/2002
County
Fulton
Street
811 Park Ridge Ln Apt. D
City
Roswell
State
GA
Zip
30076-
Cell
(678) 851-6164
Family Status
Child/Youth
COB
Mexico
Gender
Female Child
Housing
Single Family
Education Level
Grade school
Home Owner
No

Parents Information

Name DOB COB
Mother Yanin Ceja 11/26/1982 Mexico
Father Eduardo Martinez 05/21/1977 Mexico
Step Parent Saul Garcia 10/12/1989 Mexico
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother w/Stepfather
Name of School
Mimosa Element
Grade
3rd.
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
YES
Authoritation Child
No
DOY PERMISO
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
Y. Garcia
Data Entry
K. Aleman