TEO-KEL-05

Code
TEO-KEL-05
Mercy ID
V-03062-11
Encounter Date
04/29/2009
Last
Teodoro
First
Kelley
DOB
05/06/2005
County
Dekalb
Street
2205 Briarcliff Road Apt. 19
City
Atlanta
State
GA
Zip
30329-
Cell
(404) 447-0384
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 Maria Lourdes Vargas 02/11/1983 Mexico
Father Antonio Teodoro Gomez 01/14/1978 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother
Name of School
Briarvista Montesoti
Grade
Pre-K
Who Can't Pickup the Child

Media

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