RAM-DAN-12

Code
RAM-DAN-12
Mercy ID
V-03462-12
Encounter Date
10/27/2010
Last
Ramirez
First
Danexi
DOB
03/06/2008
County
Dekalb
Street
2761 Shallowford Rd.
City
Atlanta
State
GA
Zip
30341-
Cell
(770) 885-6938
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Maryuri mejia 01/06/1977 Honduras
Father Jose Luis Ramirez 01/13/1978 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Asthma
Lives With
Mother
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

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