ELI-IVA-95

Code
ELI-IVA-95
Mercy ID
V-03125-21
Encounter Date
01/27/2010
Last
Elias
First
Ivan
DOB
08/09/1995
County
Fulton
Street
P.O. Box 767581
City
Roswell
State
GA
Zip
30076-
Cell
(678) 778-2695
Family Status
Single parent w/children
COB
Perú
Gender
Male Child
Housing
Doubling Up
Education Level
Grade school
Home Owner
No

Parents Information

Name DOB COB
Mother Milagros del Aguila 10/26/1971 Perú
Father Alan Elias 03/04/1967 Perú
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Polen/astma
Lives With
Mother
Name of School
Holcombridge M.S.
Grade
8th.
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