ROB-MAN-68

Code
ROB-MAN-68
Mercy ID
V-01562-02
Encounter Date
06/05/1998
Last
Roblero
First
Manuel
DOB
05/23/1968
County
Other
Street
3421 Cumberland H4
City
Chamblee
State
GA
Zip
30341-
Home
(000) 000-0000
Cell
(000) 000-0000
Family Status
Two parent family w/children
COB
Mexico
Gender
Male
Housing
Other
Education Level
Other
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
F. Perez
Data Entry
K. Aleman