DOM-MAR-58

Code
DOM-MAR-58
Mercy ID
V-03228-01
Encounter Date
01/25/2010
Last
Dominguez
First
Maria e
DOB
09/02/1958
County
Clayton
Street
6500 Bocagrande Blvd.
City
Forest park
State
GA
Zip
30297-
Home
(678) 519-3491
Cell
(404) 886-4808
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Adult, no formal education
Home Owner
YES

Parents Information

Name DOB COB
Mother N/A N/A N/A
Father N/A N/A N/A
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
N/A
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
J. Perez
Data Entry
J. Manzo