BRO-JAC-75

Code
BRO-JAC-75
Mercy ID
V-02377-01
Encounter Date
12/27/2006
Last
Brown
First
Jacqueline
DOB
07/25/1975
County
Gwinnett
Street
2604 Tree house
City
Norcross
State
GA
Zip
30093-
Family Status
Single parent w/children
COB
Colombia
Gender
Female
Housing
Shelter
Education Level
High school graduate
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
J. Manzo