SEG-JOS-72

Code
SEG-JOS-72
Mercy ID
V-02615-02
Encounter Date
10/21/2008
Last
Segura
First
Jose
DOB
03/16/1972
County
Gwinnett
Street
6660 Buckingham Ct.
City
Norcross
State
GA
Zip
30093-
Cell
(678) 520-9498
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Single Family
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
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