LEO-ESP-59

Code
LEO-ESP-59
Mercy ID
V-01972-01
Encounter Date
04/22/1999
Last
Leon
First
Esperanza
DOB
12/08/1959
County
Other
Street
not given
City
Other
State
GA
Zip
N/A
Home
(000) 000-0000
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
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