ULL-LUI-84

Code
ULL-LUI-84
Mercy ID
V-03100-02
Encounter Date
07/14/2009
Last
Ulloa
First
Luis
DOB
02/17/1984
County
Cobb
Street
1750 Mary Ada Dr. NW
City
Kennesaw
State
GA
Zip
30144-
Home
(404) 952-8314
Cell
(404) 578-1979
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Single Family
Education Level
High school graduate
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. Manzo
Data Entry
J. Manzo