MAC-POT-75

Code
MAC-POT-75
Mercy ID
V-02686-01
Encounter Date
01/15/2008
Last
Machado
First
Potira
DOB
12/19/1975
County
Fayette
Street
105 Deer Creek Ct.
City
Fairburn
State
GA
Zip
30213-
Home
(678) 517-0747
Cell
(770) 993-4581
Family Status
Single parent w/children
COB
Brazil
Gender
Female
Housing
Doubling Up
Education Level
Some College
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
J. Perez
Data Entry
J. Manzo