CEP-JOS-49

Code
CEP-JOS-49
Mercy ID
V-01695-02
Encounter Date
09/14/2004
Last
Cepeda
First
Jose a
DOB
05/05/1949
County
Fulton
Street
1155 Simpson
City
Atlanta
State
GA
Zip
30314-
Home
(678) 755-3215
Family Status
Single parent w/children
COB
Mexico
Gender
Male
Housing
Doubling Up
Education Level
some high school
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
R. Miranda
Data Entry
K. Aleman