DIE-CAR-62

Code
DIE-CAR-62
Mercy ID
V-00141-02
Encounter Date
03/13/2000
Last
Diez
First
Carlos
DOB
04/30/1962
County
Gwinnett
Street
3450 Breckin Ridge Apt. 923-B
City
Duluth
State
GA
Zip
30096-
Home
(770) 931-1714
Family Status
Two parent family w/children
COB
Colombia
Gender
Male
Housing
Doubling Up
Education Level
Vocational/Technical
Home Owner
YES

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
No
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
R. Miranda
Data Entry
Y. Garcia