LUS-JOS-02

Code
LUS-JOS-02
Mercy ID
V-03322-21
Encounter Date
02/23/2011
Last
Lustre
First
Jose
DOB
07/02/2002
County
Clayton
Street
976 Forest Ave. Apt. D-42
City
Forest park
State
GA
Zip
30297-
Cell
(404) 748-2831
Family Status
Child/Youth
COB
Mexico
Gender
Male Child
Housing
Single Family
Education Level
Grade school
Home Owner
No

Parents Information

Name DOB COB
Mother Adriana Nuñez 09/17/1970 Mexico
Father N/A N/A Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Penicilina
Lives With
Mother
Name of School
Edmon Elem.
Grade
3rd.
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
Volunteer
Data Entry
J. Manzo