AVI-NAA-04

Code
AVI-NAA-04
Mercy ID
V-03087-12
Encounter Date
06/10/2009
Last
Avila
First
Natalie
DOB
08/03/2004
County
Clayton
Street
955 Pineglen Dr.
City
Forest park
State
GA
Zip
30297-
Cell
(678) 789-0270
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Single Family
Education Level
Grade school
Home Owner
No

Parents Information

Name DOB COB
Mother Leticia Avila 04/14/1975 Mexico
Father Mario Avila Ventura021975 02/19/1975 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Purpura, Moretones en la piel
Lives With
Mother
Name of School
Br. Hoynie
Grade
Kinder
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
C. Martinez
Data Entry
J. Manzo