CHA-ROS-83

Code
CHA-ROS-83
Mercy ID
V-03067-01
Encounter Date
05/12/2009
Last
Chavez
First
Rosa
DOB
08/21/1983
County
Fulton
Street
1805 Rosemot Dr.
City
Roswell
State
GA
Zip
30076-
Cell
(770) 875-9965
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high 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
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
J. Perez
Data Entry
J. Manzo