PIN-FAB-57

Code
PIN-FAB-57
Mercy ID
V-01735-01
Encounter Date
10/29/2004
Last
Pineda
First
Fabiola
DOB
01/10/1957
County
Dekalb
Street
1006 Soak Chase Dr.
City
Norcross
State
GA
Zip
30084-
Home
(000) 000-0000
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
High school graduate
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