DOM-EVI-85

Code
DOM-EVI-85
Mercy ID
V-03449-01
Encounter Date
10/25/2010
Last
Dominguez
First
Evin
DOB
01/27/1985
County
Gwinnett
Street
3726 Jackson Shoals Court
City
Lawrenceville
State
GA
Zip
30044-
Cell
(404) 660-9365
Family Status
Adult couple-no children
COB
USA
Gender
Female
Housing
Single Family
Education Level
High school graduate
Home Owner
YES

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

NO 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