ROD-BER-73

Code
ROD-BER-73
Mercy ID
V-03277-01
Encounter Date
03/09/2010
Last
Palmerin
First
Bertha
DOB
02/17/1973
County
Dekalb
Street
1195 Reilly Lane
City
Clarkston
State
GA
Zip
30021-
Home
(404) 508-8958
Cell
(404) 569-8819
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Some College
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
YES
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
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
G. Landeros
Data Entry
J. Manzo