SAN-SEB-07

Code
SAN-SEB-07
Mercy ID
V-03328-21
Encounter Date
06/02/2010
Last
Santana
First
Sebastian
DOB
09/23/2007
County
Gwinnett
Street
5667 Harbinwood Dr.
City
Norcross
State
GA
Zip
30093-
Cell
(404) 707-1740
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Maria Auxiliadora Rubio 05/30/1965 Mexico
Father Alfredo Santana 01/12/1976 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Ezema. Alegico a Pescado.
Lives With
Mother
Name of School
N/A
Grade
N/A
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
YES
Authoritation Child
No
DOY PERMISO
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
C. Martinez
Data Entry
J. Manzo