ESP-MEL-08

Code
ESP-MEL-08
Mercy ID
V-02824-22
Encounter Date
10/29/2008
Last
España
First
Melvin
DOB
09/20/2008
County
Gwinnett
Street
1507 Hunters Club
City
Norcross
State
GA
Zip
30093-
Cell
(404) 951-2506
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Ligia Aguilar 03/31/1980 Honduras
Father Melvin España 12/17/1977 Honduras
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Alergico a un medicamento, no sabe exactamente cual.
Lives With
Parents
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
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
C. Martinez
Data Entry
J. Manzo