GOM-LOR-86

Code
GOM-LOR-86
Mercy ID
V-03329-01
Encounter Date
05/18/2010
Last
Gomez
First
Lorena
DOB
01/18/1986
County
Dekalb
Street
3061 Oakcliff Rd. Apt. 115
City
Doraville
State
GA
Zip
30340-
Home
(770) 455-9774
Cell
(678) 600-2678
Family Status
Single parent w/children
COB
Colombia
Gender
Female
Housing
Doubling Up
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
No
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
J. Perez
Data Entry
J. Manzo