CRU-MAR-65

Code
CRU-MAR-65
Mercy ID
V-01942-01
Encounter Date
06/20/2005
Last
Cruz
First
Martha
DOB
08/24/1965
County
Gwinnett
Street
4262 Pleasant Lake Village Lane Apt A
City
Duluth
State
GA
Zip
30096-
Home
(770) 497-9574
Family Status
Single parent 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
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. Manzo
Data Entry
K. Aleman