PIN-SUS-81

Code
PIN-SUS-81
Mercy ID
V-02721-01
Encounter Date
06/22/2010
Last
Pinal
First
Susana
DOB
10/15/1981
County
Clayton
Street
6410 Lanier Dr. Apt. 8
City
Morrow
State
GA
Zip
30260-
Cell
(404) 556-3207
Family Status
Single parent w/children
COB
Mexico
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
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
G. Landeros
Data Entry
J. Manzo