BAZ-ROM-82

Code
BAZ-ROM-82
Mercy ID
V-02464-01
Encounter Date
04/11/2007
Last
Bazan
First
Romeli
DOB
11/21/1982
County
Fulton
Street
221 Creekfide Way
City
Roswell
State
GA
Zip
30076-
Cell
(404) 552-2549
Family Status
Single parent w/children
COB
USA
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
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