GAR-JOS-05

Code
GAR-JOS-05
Mercy ID
V-03139-22
Encounter Date
08/19/2009
Last
Garcia
First
Jose
DOB
11/08/2005
County
Dekalb
Street
3536 Buford Hwy # 8
City
Atlanta
State
GA
Zip
30329-
Cell
(404) 246-4333
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Doubling Up
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Wendy Campos 11/14/1987 Mexico
Father Jose Garcia 03/19/1982 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Astma. Inhalador
Lives With
Parents
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
C. Martinez
Data Entry
J. Manzo