ESP-ISA-00

Code
ESP-ISA-00
Mercy ID
V-03032-22
Encounter Date
10/21/2009
Last
Espinoza
First
Isai
DOB
05/28/2000
County
Clayton
Street
7022 Homestead Road
City
Rex
State
GA
Zip
30273-
Home
(678) 289-5833
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Grade school
Home Owner
YES

Parents Information

Name DOB COB
Mother Mercedes Sanchez 05/12/1973 Mexico
Father Trinidad Espinoza 12/27/1967 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Parents
Name of School
Smith Elementary
Grade
4th.
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
C. Martinez
Data Entry
J. Manzo