QUI-PAT-72

Code
QUI-PAT-72
Mercy ID
V-03405-01
Encounter Date
09/02/2010
Last
Quiroz
First
Patricia
DOB
05/25/1972
County
Fulton
Street
4717 Roswell Road Apt. E-1
City
Atlanta
State
GA
Zip
30342-
Cell
(404) 437-4233
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
some high 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
No
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
J. Perez
Data Entry
J. Manzo