MDZ-FAB-04

Code
MDZ-FAB-04
Mercy ID
V-03442-12
Encounter Date
11/03/2010
Last
Mendez
First
Fabiola
DOB
01/08/2004
County
Fulton
Street
3815 MLK Jr Dr. Apt. F 5
City
Atlanta
State
GA
Zip
30331-
Cell
(678) 882-9463
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Single Family
Education Level
Grade school
Home Owner
YES

Parents Information

Name DOB COB
Mother Deodora Mendez 07/02/1977 Guatemala
Father Fabian Vazquez N/A Mexico
Step Parent Jose Perez 06/21/1985 Mexico
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother
Name of School
CA town elem
Grade
1st.
Who Can't Pickup the Child

Media

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