JIM-ROS-67

Code
JIM-ROS-67
Mercy ID
V-03456-01
Encounter Date
10/22/2010
Last
Jimenez
First
Rosa
DOB
04/30/1967
County
Hall
Street
999 NO LA QUISO DAR
City
Gainsville
State
GA
Zip
30509-
Cell
(678) 719-1167
Family Status
Single parent w/children
COB
Dominican Rep
Gender
Female
Housing
Single Family
Education Level
Some College
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