MEN-GUA-79

Code
MEN-GUA-79
Mercy ID
V-02371-01
Encounter Date
11/25/2006
Last
Mendez
First
Guadalupe
DOB
12/11/1979
County
Gwinnett
Street
314 High Point
City
Snellville
State
GA
Zip
30078-
Home
(999) 999-9999
Cell
(678) 437-7152
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
some high 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
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
G. Landeros
Data Entry
J. Manzo