ESP-MIR-67

Code
ESP-MIR-67
Mercy ID
V-03221-01
Encounter Date
12/08/2009
Last
Espinal
First
Mirtha
DOB
07/10/1967
County
Cherokee
Street
204 Ridgepoint Ct.
City
Woodstock
State
GA
Zip
30189-
Cell
(678) 600-9196
Family Status
Single adult
COB
Dominican Rep
Gender
Female
Housing
Single Family
Education Level
Some College
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