ROD-DAN-03

Code
ROD-DAN-03
Mercy ID
V-03384-21
Encounter Date
08/04/2010
Last
Rodriguez
First
Daniel
DOB
12/12/2003
County
Dekalb
Street
3201 Henderson Mill Rd. Apt. 21 C
City
Atlanta
State
GA
Zip
30341-
Cell
(404) 399-9541
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Grade school
Home Owner
YES

Parents Information

Name DOB COB
Mother Maria Saavedra 08/17/1982 Mexico
Father Manuel de Jesus Rodriguez 04/24/1980 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
Evondale Elem/
Grade
1st.
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