GAL-BLA-86

Code
GAL-BLA-86
Mercy ID
V-01898-01
Encounter Date
05/04/2005
Last
Gallegos
First
Blanca
DOB
02/21/1986
County
Dekalb
Street
1419 N. Cliff Valley Way Apt C
City
Atlanta
State
GA
Zip
30319-
Home
(404) 633-3742
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
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
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. Manzo
Data Entry
K. Aleman