VEG-FAT-06

Code
VEG-FAT-06
Mercy ID
V-02862-12
Encounter Date
08/06/2008
Last
Garcia
First
Fatima
DOB
06/07/2006
County
Gwinnett
Street
6148 Susan Lane
City
Doraville
State
GA
Zip
30340-
Cell
(678) 668-0211
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Single Family
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Reynalda Vega 02/16/1981 USA
Father Moises Roman 08/28/1982 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Parents
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
YES
Authoritation Child
No
DOY PERMISO
No
Limitado Educativo
YES
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
C. Martinez
Data Entry
J. Manzo