DIA-DAN-78

Code
DIA-DAN-78
Mercy ID
V-01113-01
Encounter Date
02/12/2003
Last
Diaz
First
Dana
DOB
12/29/1978
County
Dekalb
Street
9940 W. National Dir Apt. A
City
Tucker
State
GA
Zip
30084-
Home
(770) 374-4794
Family Status
Adult coupie-no children
COB
Mexico
Gender
Female
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
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