ALJ-ESR-04

Code
ALJ-ESR-04
Mercy ID
V-03348-11
Encounter Date
08/04/2010
Last
Aljarah
First
Esra
DOB
06/16/2004
County
Fulton
Street
11 Sweetberry Court
City
Alpharetta
State
GA
Zip
30005-
Cell
(404) 587-8863
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Single Family
Education Level
Grade school
Home Owner
YES

Parents Information

Name DOB COB
Mother Iris Vargas 10/10/1976 Colombia
Father Hytam Aljarah N/A Jordan
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Pork, Gellatine
Lives With
Mother
Name of School
Amana Academy
Grade
1st.
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
Volunteer
Data Entry
J. Manzo