PED-SUS-85

Code
PED-SUS-85
Mercy ID
V-03433-01
Encounter Date
02/15/2011
Last
Pedro
First
Susana
DOB
08/11/1985
County
Dekalb
Street
3671 Shallowford Rd. # A
City
Doraville
State
GA
Zip
30340-
Cell
(404) 671-7956
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade 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

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