PER-MAR-77

Code
PER-MAR-77
Mercy ID
V-02994-01
Encounter Date
01/28/2009
Last
Perez
First
Maria elena
DOB
10/09/1977
County
Cobb
Street
7311 Elsner Rd.
City
Austell
State
GA
Zip
30168-
Cell
(678) 260-7047
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
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
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
C. Martinez
Data Entry
J. Manzo