AVI-TAN-02

Code
AVI-TAN-02
Mercy ID
V-03122-11
Encounter Date
07/15/2009
Last
Avila
First
Tania
DOB
10/01/2002
County
Gwinnett
Street
2222 Condor Drive
City
Lawrenceville
State
GA
Zip
30044-
Cell
(404) 201-9065
Family Status
Child/Youth
COB
Mexico
Gender
Female Child
Housing
Single Family
Education Level
Grade school
Home Owner
No

Parents Information

Name DOB COB
Mother Ana Avila 08/21/1980 Mexico
Father N/A N/A Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother w/Stepfather
Name of School
Alford Elementary
Grade
1st.
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