CIS-BLA-77

Code
CIS-BLA-77
Mercy ID
V-01884-01
Encounter Date
04/25/2005
Last
Cisneros
First
Blanca estela
DOB
10/21/1977
County
Clayton
Street
669 Glendon Dr.
City
Morrow
State
GA
Zip
30260-
Home
(404) 399-0715
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Shelter
Education Level
Grade 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
YES
Relative
YES
Stranger
YES
NOTES
Sus niñas estan en Mexico
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