NAA-ANG-04

Code
NAA-ANG-04
Mercy ID
V-03292-11
Encounter Date
03/07/2010
Last
Navarrete
First
Angelica
DOB
03/05/2004
County
Dekalb
Street
3132 Buford Hwy Apt. E-3
City
Atlanta
State
GA
Zip
30329-
Cell
(404) 438-2219
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Doubling Up
Education Level
Grade school
Home Owner
YES

Parents Information

Name DOB COB
Mother Maria A Olmedo 02/28/1979 Mexico
Father Antonio Navarrete 06/13/1972 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Zitromax (medicina)
Lives With
Mother
Name of School
Windwood Elem
Grade
1st.
Who Can't Pickup the Child

Media

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