DOR-EDI-77

Code
DOR-EDI-77
Mercy ID
V-03474-01
Encounter Date
11/15/2010
Last
Dorantes
First
Edith
DOB
02/21/1977
County
Fulton
Street
6125 Northwood Dr.
City
Sandy springs
State
GA
Zip
30342-
Cell
(678) 876-6969
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
No
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
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
G. Landeros
Data Entry
J. Manzo