AVI-LET-73

Code
AVI-LET-73
Mercy ID
V-03087-01
Encounter Date
06/09/2009
Last
Avila
First
Leticia
DOB
04/14/1973
County
Clayton
Street
955 Pinelen Dr.
City
Forest park
State
GA
Zip
30297-
Home
(678) 789-0270
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
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