VEL-ETE-76

Code
VEL-ETE-76
Mercy ID
V-00511-01
Encounter Date
09/19/2002
Last
Velasquez
First
Etelvina
DOB
10/24/1976
County
Dekalb
Street
1627 Briarwood Rd.
City
Atlanta
State
GA
Zip
00000-0000
Home
(404) 248-1163
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
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
YES
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
J. Perez
Data Entry
K. Aleman