VER-SEL-63

Code
VER-SEL-63
Mercy ID
V-02479-02
Encounter Date
05/01/2007
Last
Vera
First
Selestino
DOB
05/19/1963
County
Fulton
Street
1149 Thomas Dr.
City
Roswell
State
GA
Zip
30075-
Home
(770) 518-8867
Cell
(404) 838-0979
Family Status
Single adult
COB
Mexico
Gender
Male
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
J. Manzo
Data Entry
J. Manzo