ROQ-VAL-02

Code
ROQ-VAL-02
Mercy ID
V-01398-11
Encounter Date
10/29/2003
Last
Roque
First
Valeria
DOB
12/31/2002
County
Fulton
Street
294 Deering Rd. NW Apt 2207
City
Atlanta
State
GA
Zip
30309-
Home
(000) 000-0000
Family Status
Attached youth
COB
Mexico
Gender
Female Child
Housing
Not Homeless
Education Level
Child, not in school
Home Owner
No

Parents Information

Name DOB COB
Mother Gabriela Ramirez 06/16/1976 Mexico
Father Bernardo Roque 09/23/1974 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Parents
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
K. Aleman
Data Entry
K. Aleman