FLO-JOH-02

Code
FLO-JOH-02
Mercy ID
V-03028-23
Encounter Date
09/02/2009
Last
Flores
First
John
DOB
01/24/2002
County
Gwinnett
Street
3400 Sweetwater Road. Apt. 1109
City
Lawrenceville
State
GA
Zip
30044-
Cell
(678) 334-0292
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Grade school
Home Owner
YES

Parents Information

Name DOB COB
Mother Beatriz Flores 07/29/1963 Mexico
Father Paulin Flores 06/22/1967 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Astma, Inhalador. Alergico al polvo y seasonal allergies
Lives With
Mother
Name of School
Corley Elem
Grade
3rd.
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
C. Martinez
Data Entry
J. Manzo