GAL-JAI-03

Code
GAL-JAI-03
Mercy ID
V-03392-21
Encounter Date
08/25/2010
Last
Galarza
First
Jair
DOB
10/26/2003
County
Cobb
Street
2345 Cobb Parkway
City
Smyrna
State
GA
Zip
30080-
Cell
(404) 438-3721
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 Aida Bautista 01/23/1980 Mexico
Father Jose Galarza 04/12/1975 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother
Name of School
Branby 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
C. Martinez
Data Entry
J. Manzo