ARR-PAT-64

Code
ARR-PAT-64
Mercy ID
V-00002-01
Encounter Date
01/05/2000
Last
Arrieta
First
Patricia
DOB
06/30/1964
County
Dekalb
Street
4717 Roswell Rd. Apt E-2
City
Atlanta
State
GA
Zip
30342-
Home
(404) 421-0236
Cell
(678) 365-7717
Family Status
Single parent w/children
COB
Mexico
Gender
Female
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
YES
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. Manzo
Data Entry
K. Aleman