DOM-ROG-67

Code
DOM-ROG-67
Mercy ID
V-00327-02
Encounter Date
10/31/2000
Last
Dominguez
First
Rogelio
DOB
07/27/1967
County
Fulton
Street
303 Semoin Rd. Apt. 7
City
Furburn
State
GA
Zip
30213-
Home
(770) 306-5185
Family Status
Single parent w/children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
some high school
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
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
R. Miranda
Data Entry
K. Aleman