PER-EDI-80

Code
PER-EDI-80
Mercy ID
V-02131-01
Encounter Date
01/16/2006
Last
Perez
First
Edith
DOB
07/17/1980
County
Dekalb
Street
3510 Buford Hwy B4
City
Atlanta
State
GA
Zip
30329-
Home
(404) 321-3074
Cell
(678) 663-9079
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
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
R. Gonzalez