VER-GAL-66

Code
VER-GAL-66
Mercy ID
V-00982-02
Encounter Date
03/19/2002
Last
Vergara diaz
First
Galo
DOB
12/01/1966
County
Fulton
Street
4558 Roswell Rd. Apt. H-4
City
Atlanta
State
GA
Zip
30342-
Home
(404) 943-1925
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
some high 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
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