ROD-ISA-02

Code
ROD-ISA-02
Mercy ID
V-03277-21
Encounter Date
03/31/2010
Last
Rodriguez
First
Isaac
DOB
11/08/2002
County
Dekalb
Street
1195 Reilly Lane
City
Clarkston
State
GA
Zip
30021-
Home
(404) 508-8958
Cell
(404) 569-8819
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Grade school
Home Owner
YES

Parents Information

Name DOB COB
Mother Bertha Palmerin 02/17/1973 Mexico
Father Isaias Rodriguez 06/07/1973 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Parents
Name of School
Jolly Elem
Grade
1st.
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
YES
Authoritation Child
No
DOY PERMISO
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
C. Martinez
Data Entry
J. Manzo