BUR-MON-76

Code
BUR-MON-76
Mercy ID
V-02625-01
Encounter Date
10/22/2007
Last
Burgos
First
Monica
DOB
02/02/1976
County
Fayette
Street
124 WestMont Way
City
Tyreno
State
GA
Zip
30290-
Cell
(678) 548-6906
Family Status
Two parent family w/children
COB
Puerto Rico
Gender
Female
Housing
Single Family
Education Level
College Degree
Home Owner
YES

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

DOY PERMISO
Authoritation Parent
No
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
J. Perez
Data Entry
J. Manzo