MAC-JAI-03

Code
MAC-JAI-03
Mercy ID
W-00002-21
Encounter Date
08/19/2009
Last
Macias
First
Jaiden
DOB
12/07/2003
County
Dekalb
Street
279 Southerland Terrace NE
City
Atlanta
State
GA
Zip
30307-
Cell
(210) 288-7770
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Preschool
Home Owner
YES

Parents Information

Name DOB COB
Mother Rosemarie Lillianne Macia 09/20/1983 USA
Father Adam C. Leard 09/27/1980 Mexico
Step Parent Bryant Bayles N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother
Name of School
Mary Lin
Grade
Kinder
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
C. Martinez
Data Entry
J. Manzo