GUT-AMA-64

Code
GUT-AMA-64
Mercy ID
V-02151-01
Encounter Date
01/31/2006
Last
Gutierrez
First
Amanda
DOB
11/13/1964
County
Gwinnett
Street
2584 Gwim Dr
City
Norcross
State
GA
Zip
30071-
Home
(770) 734-0623
Cell
(404) 247-7770
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Grade school
Home Owner
YES

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. Perez
Data Entry
R. Gonzalez