MED-ROS-71

Code
MED-ROS-71
Mercy ID
V-02732-01
Encounter Date
03/19/2008
Last
Medina
First
Rosa
DOB
04/25/1971
County
Clayton
Street
18 Lakeview Dr.
City
Riverdale
State
GA
Zip
30296-
Home
(770) 477-7546
Family Status
Two parent family w/children
COB
Panamá
Gender
Female
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. Perez
Data Entry
J. Manzo