DOM-CAN-68

Code
DOM-CAN-68
Mercy ID
V-00327-01
Encounter Date
11/07/2000
Last
Dominguez
First
Candy
DOB
02/06/1968
County
Fulton
Street
303 Sewoin Rd. Apt. 7
City
Furburn
State
GA
Zip
30212-
Home
(770) 306-5185
Family Status
Two parent family w/children
COB
USA
Gender
Female
Housing
Not Homeless
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
No
Relative
No
Stranger
No
NOTES
Signed consent form and promesa before the fire
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
J. Perez
Data Entry
K. Aleman