PER-JES-06

Code
PER-JES-06
Mercy ID
V-02994-22
Encounter Date
01/28/2009
Last
Perez
First
Jesse
DOB
06/25/2006
County
Cobb
Street
7311 Elsner Rd.
City
Austell
State
GA
Zip
30168-
Cell
(678) 260-7047
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Single Family
Education Level
Preschool
Home Owner
YES

Parents Information

Name DOB COB
Mother Maria E Perez 10/09/1977 Mexico
Father Inocente Vega N/A Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Medicamentos: Predisodine & zitromizaz Comida:Huevo, Crema de Cacahuate, maiz, comida organica.
Lives With
Mother
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
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
C. Martinez
Data Entry
J. Manzo