SIE-IVI-72

Code
SIE-IVI-72
Mercy ID
V-03522-01
Encounter Date
02/01/2011
Last
Sierra
First
Ivis
DOB
07/08/1972
County
Cobb
Street
1327 Laura Ln.
City
Austell
State
GA
Zip
30168-
Home
(678) 398-9821
Family Status
Single parent w/children
COB
Honduras
Gender
Female
Housing
Single Family
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