PER-AND-10

Code
PER-AND-10
Mercy ID
V-02172-23
Encounter Date
06/30/2010
Last
Perez
First
Andres
DOB
06/02/2010
County
Cobb
Street
1245 Brandl SW
City
Marietta
State
GA
Zip
30008-
Cell
(678) 334-6660
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Esmeralda Silva 03/17/1975 Mexico
Father Mauricio Perez 05/05/1973 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Parents
Name of School
N/A
Grade
N/A
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
Volunteer
Data Entry
J. Manzo