MOR-JUS-07

Code
MOR-JUS-07
Mercy ID
V-02940-21
Encounter Date
11/11/2008
Last
Moreno
First
Justin
DOB
06/06/2007
County
Other
Street
228 Coconut
City
Cary
State
GA
Zip
27511-
Home
(404) 513-0753
Cell
(919) 539-9383
Family Status
Child/Youth
COB
USA
Gender
Male Child
Home Owner
YES

Parents Information

Name DOB COB
Mother Ana Leiva 03/31/1966 Perú
Father N/A N/A Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother
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