ROS-CRI-79

Code
ROS-CRI-79
Mercy ID
V-03042-01
Encounter Date
04/13/2009
Last
Rosas
First
Cristina
DOB
07/25/1979
County
Fulton
Street
66 Northwood Dr. Apt. 105
City
Atlanta
State
GA
Zip
30342-
Cell
(678) 301-8411
Family Status
Two parent family 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
G. Landeros
Data Entry
J. Manzo