GOM-AMP-58

Code
GOM-AMP-58
Mercy ID
V-03161-01
Encounter Date
09/16/2009
Last
Gomez
First
Amparo ii
DOB
10/09/1958
County
Dekalb
Street
3506 Buford Hwy
City
Atlanta
State
GA
Zip
30329-
Cell
(404) 246-4333
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Vocational/Technical
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. Perez
Data Entry
J. Manzo