SEG-JOS-99

Code
SEG-JOS-99
Mercy ID
V-02615-21
Encounter Date
05/21/2008
Last
Segura
First
Jose
DOB
05/26/1999
County
Gwinnett
Street
6660 Buckinham Cr.
City
Norcross
State
GA
Zip
30093-
Cell
(678) 993-7752
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Grade school
Home Owner
YES

Parents Information

Name DOB COB
Mother Tonya Segura N/A USA
Father Jose Alfredo Segura 03/16/1972 Mexico
Step Parent Zhenia Jaime 09/30/1973 Mexico
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Father w/Stepmother
Name of School
Nesbit Elementary
Grade
3rd.
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