DOM-ARI-78

Code
DOM-ARI-78
Mercy ID
V-01692-01
Encounter Date
09/09/2004
Last
Dominguez
First
Arisleyda
DOB
06/02/1978
County
Gwinnett
Street
1300 Beaver Ruin Rd. Apt 6309
City
Norcross
State
GA
Zip
30093-
Home
(770) 572-6734
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Vocational/Technical
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
J. Perez
Data Entry
K. Aleman