CAS-ADR-79

Code
CAS-ADR-79
Mercy ID
V-02995-01
Encounter Date
02/03/2009
Last
Casimiro
First
Adriana
DOB
12/09/1979
County
Polk
Street
522 Fcave Spring
City
Cedartown
State
GA
Zip
30125-
Home
(770) 748-7325
Cell
(678) 988-2865
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
some high 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
YES
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
J. Perez
Data Entry
J. Manzo