MON-MIC-71

Code
MON-MIC-71
Mercy ID
V-03345-01
Encounter Date
06/16/2010
Last
Mondragon
First
Miceli
DOB
01/16/1971
County
Dekalb
Street
2111 Gabless Way
City
Atlanta
State
GA
Zip
30329-
Cell
(678) 368-2359
Family Status
Single parent 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
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

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