BLA-MAR-62

Code
BLA-MAR-62
Mercy ID
V-02521-01
Encounter Date
06/11/2007
Last
Blanco
First
Maria de lourdes
DOB
05/12/1962
County
Fulton
Street
410 Riverwood Apt. A
City
Roswell
State
GA
Zip
99999-999
Cell
(678) 330-8174
Family Status
Single adult
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
H.S. equivalency diploma
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