PER-REY-76

Code
PER-REY-76
Mercy ID
V-03342-01
Encounter Date
06/15/2010
Last
Perez
First
Reyna
DOB
04/28/1976
County
Gwinnett
Street
4515 Brandon Dr. SW
City
Lilburn
State
GA
Zip
30047-
Home
(770) 985-2583
Cell
(404) 867-0293
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high school
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