VEL-MIT-02

Code
VEL-MIT-02
Mercy ID
V-02962-11
Encounter Date
12/10/2008
Last
Velasquez
First
Mitchell
DOB
01/05/2002
County
Fulton
Street
295 Winding River Apt. L
City
Atlanta
State
GA
Zip
30350-
Home
(404) 748-2805
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Doubling Up
Education Level
Grade school
Home Owner
YES

Parents Information

Name DOB COB
Mother Florinda Silverio 01/18/1969 Mexico
Father Amado Velasquez 06/09/1962 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Durasno Yogurt
Lives With
Mother
Name of School
Dunwoody Spring
Grade
1st.
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
YES
Authoritation Child
No
DOY PERMISO
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
C. Martinez
Data Entry
J. Manzo