PER-MAR-90

Code
PER-MAR-90
Mercy ID
V-03231-01
Encounter Date
01/05/2010
Last
Perez
First
Maria brenda
DOB
10/14/1990
County
Polk
Street
1343 Brooks St.
City
Cedartown
State
GA
Zip
30125-
Cell
(678) 347-6342
Family Status
Single parent w/children
COB
Guatemala
Gender
Female
Housing
Doubling Up
Education Level
Adult, no formal education
Home Owner
No

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
G. Landeros
Data Entry
J. Manzo