DOM-SUL-79

Code
DOM-SUL-79
Mercy ID
V-02350-01
Encounter Date
10/31/2006
Last
Dominguez
First
Sulma
DOB
12/28/1979
County
Gwinnett
Street
793 Sandune Dr.
City
Norcross
State
GA
Zip
30093-
Cell
(678) 558-7338
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
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
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
G. Landeros
Data Entry
J. Manzo