GAR-SAM-77

Code
GAR-SAM-77
Mercy ID
V-03448-01
Encounter Date
10/26/2010
Last
Garcia
First
Samira
DOB
12/15/1977
County
Fulton
Street
125 northwood Dr.
City
Sandy springs
State
GA
Zip
30342-
Cell
(404) 399-7978
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
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
YES
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