PER-NIC-85

Code
PER-NIC-85
Mercy ID
V-02830-01
Encounter Date
06/20/2008
Last
Perez
First
Nicolasa
DOB
02/01/1985
County
Fulton
Street
55 Norwood Road
City
Sandy springs
State
GA
Zip
30342-
Cell
(678) 755-8287
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade school
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