SOR-ANA-02

Code
SOR-ANA-02
Mercy ID
V-03400-11
Encounter Date
09/08/2010
Last
Soriano
First
Ana karina
DOB
04/19/2002
County
Dekalb
Street
4695 North Peachtree Rd.
City
Dunwoody
State
GA
Zip
30338-
Home
(678) 615-7948
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Single Family
Education Level
Grade school
Home Owner
No

Parents Information

Name DOB COB
Mother Ariana Reyes 04/06/1981 Mexico
Father Mario Soriano 11/29/1978 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
Asma
Lives With
Parents
Name of School
Chesnut Elem
Grade
3rd.
Who Can't Pickup the Child

Media

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