CHA-ERI-82

Code
CHA-ERI-82
Mercy ID
V-02403-01
Encounter Date
02/07/2007
Last
Chavez
First
Erika
DOB
08/14/1982
County
Clayton
Street
5086 Old Dixie Hwy. Apt. 21
City
Forest park
State
GA
Zip
30297-
Cell
(404) 573-0486
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
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
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
G. Landeros
Data Entry
J. Manzo