TER-ELV-78

Code
TER-ELV-78
Mercy ID
V-03360-01
Encounter Date
07/01/2010
Last
Terrazas
First
Elvira
DOB
08/20/1978
County
Douglass
Street
4064 Shumas Ct.
City
Douglassville
State
GA
Zip
30135-
Home
(770) 577-5006
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
Grade school
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
No
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
G. Landeros
Data Entry
J. Manzo