ACO-ELE-66

Code
ACO-ELE-66
Mercy ID
V-01507-01
Encounter Date
03/01/2004
Last
Acosta
First
Elena
DOB
01/12/1966
County
Gwinnett
Street
4280 Souph Lee St.
City
Buford
State
GA
Zip
30518-
Home
(678) 714-7457
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Adult, no formal education
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