HUA-RIT-64

Code
HUA-RIT-64
Mercy ID
V-03287-01
Encounter Date
03/08/2010
Last
Huaca
First
Rita
DOB
09/05/1964
County
Gwinnett
Street
2212 Westford Dr. NW
City
Norcross
State
GA
Zip
30071-
Cell
(678) 698-5231
Family Status
Single parent w/children
COB
Ecuador
Gender
Female
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
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

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