SER-ROS-05

Code
SER-ROS-05
Mercy ID
V-02691-12
Encounter Date
05/07/2008
Last
Servin
First
Roselin
DOB
05/22/2005
County
Gwinnett
Street
2605 Avalon Place
City
Lawrenceville
State
GA
Zip
30044-
Cell
(678) 612-2868
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Doubling Up
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Rosa Peña 03/05/1977 Dominican Rep
Father Rogelio Servin 03/02/1982 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother
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
C. Martinez
Data Entry
J. Manzo