PER-MAR-55

Code
PER-MAR-55
Mercy ID
V-01912-01
Encounter Date
05/25/2005
Last
Perea
First
Maria del carmen
DOB
07/11/1955
County
Forsyth
Street
24 Three cedars path #22
City
Dallas
State
GA
Zip
30157-
Home
(770) 505-6353
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
Education Level
Preschool
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
G. Landeros
Data Entry
K. Aleman