ROL-RAQ-01

Code
ROL-RAQ-01
Mercy ID
V-02519-01
Encounter Date
06/20/2007
Last
Roldan
First
Raquel
DOB
12/17/1961
County
Gwinnett
Street
1415 Gabriel Dr.
City
Lawrenceville
State
GA
Zip
30043-
Home
(770) 338-2119
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Not Homeless
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
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
G. Landeros
Data Entry
J. Manzo