GON-MIR-72

Code
GON-MIR-72
Mercy ID
V-03035-01
Encounter Date
03/26/2009
Last
Gonzalez
First
Mirian i
DOB
07/03/1972
County
Fulton
Street
8378 Roswell Road
City
Roswell
State
GA
Zip
30350-
Cell
(404) 532-8079
Family Status
Single parent w/children
COB
Nicaragua
Gender
Female
Housing
Single Family
Education Level
Some College
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
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
G. Landeros
Data Entry
J. Manzo