AMA-CAR-07

Code
AMA-CAR-07
Mercy ID
V-02111-22
Encounter Date
01/26/2009
Last
Amaya
First
Carlos uriel
DOB
11/13/2007
County
Gwinnett
Street
4300 Jimmy Carter Blvd. # 720
City
Norcross
State
GA
Zip
30093-
Home
(770) 491-3074
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Doubling Up
Education Level
Child, not in school
Home Owner
No

Parents Information

Name DOB COB
Mother Margarita Camacho 02/22/1975 Mexico
Father Carlos Amaya 10/20/1981 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Parents
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
J. Manzo