MAR-LUZ-66

Code
MAR-LUZ-66
Mercy ID
V-00195-01
Encounter Date
04/28/2000
Last
Martinez
First
Luz elena
DOB
09/12/1966
County
Gwinnett
Street
5141 Highway 78 Lot 212
City
Stone mountain
State
GA
Zip
30087-
Cell
(770) 235-7495
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Vocational/Technical
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
YES
Relative
No
Stranger
No
NOTES
Luz was not included in the grant report of 10/02-3/03 because she has been reported as driver's license in 2000. Juana gave me this form 3/13/03
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
J. Perez
Data Entry
K. Aleman