SHA-AYA-05

Code
SHA-AYA-05
Mercy ID
V-01181-12
Encounter Date
03/05/2008
Last
Shamon
First
Mary
DOB
06/24/2007
County
Dekalb
Street
3817 Church St.
City
Clarkston
State
GA
Zip
30021-
Home
(404) 508-1422
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Doubling Up
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Gabriela Ayala 11/20/1970 Mexico
Father Marveen Shamon 02/22/1973 Irak
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Estreñimiento crónico
Lives With
Parents
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
YES
Authoritation Child
No
DOY PERMISO
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
C. Martinez
Data Entry
J. Manzo