PIC-LIR-65

Code
PIC-LIR-65
Mercy ID
V-00147-01
Encounter Date
03/15/2000
Last
Picado
First
Lirise
DOB
07/12/1965
County
Cobb
Street
2560 Delk Rd Apt G-15
City
Marietta
State
GA
Zip
30067-
Home
(770) 457-1290
Family Status
Two parent family w/children
COB
Nicaragua
Gender
Female
Housing
Doubling Up
Education Level
Child, not in school
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
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
J. Perez
Data Entry
D. Gomez