MON-BLA-77

Code
MON-BLA-77
Mercy ID
V-02733-01
Encounter Date
03/01/2008
Last
Montes
First
Blanca
DOB
07/13/1977
County
Fayette
Street
5305 Merryck Dr.
City
Peachtree city
State
GA
Zip
30269-
Cell
(404) 516-8824
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
High school graduate
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
G. Landeros
Data Entry
J. Manzo