GOM-MAI-77

Code
GOM-MAI-77
Mercy ID
V-03157-01
Encounter Date
09/08/2009
Last
Gomez
First
Maria del carmen
DOB
07/15/1977
County
Douglass
Street
3726 Cindy Dr.
City
Douglasvillle
State
GA
Zip
30135-
Cell
(786) 346-1982
Family Status
Single adult
COB
Guatemala
Gender
Female
Housing
Doubling Up
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
G. Landeros
Data Entry
J. Manzo