MED-JOS-02

Code
MED-JOS-02
Mercy ID
V-03336-02
Encounter Date
05/25/2010
Last
Mederos
First
Jose
DOB
06/25/1984
County
Gwinnett
Street
4225 Janet Ct.
City
Lilburn
State
GA
Zip
30047-
Cell
(678) 698-6526
Family Status
Single adult
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
Vocational/Technical
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
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. Manzo
Data Entry
J. Manzo