ORT-DIA-87

Code
ORT-DIA-87
Mercy ID
V-01991-01
Encounter Date
09/17/2003
Last
Ortiz
First
Diana
DOB
08/06/1987
County
Dekalb
Street
2789 Shallowford #C
City
Chamblee
State
GA
Zip
30341-
Home
(678) 508-0368
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 Maria Guadalupe Dominguez 08/12/1955 Mexico
Father Alejandro Ortiz 05/03/1955 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Mother: Dominguez, Guadalupe 12/7/60 Father: Ortiz, Alejandro 5/3/54
Lives With
Parents
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. Perez
Data Entry
K. Aleman