EST-CEV-60

Code
EST-CEV-60
Mercy ID
V-03073-01
Encounter Date
05/18/2009
Last
Estrada
First
Severa
DOB
11/08/1960
County
Dekalb
Street
760 Ridge Ave.
City
Stone mountain
State
GA
Zip
30083-
Cell
(404) 516-7195
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school
Home Owner
YES

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
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