RUB-TAN-75

Code
RUB-TAN-75
Mercy ID
V-03440-01
Encounter Date
10/04/2010
Last
Rubio
First
Tania
DOB
05/18/1975
County
Jasper
Street
9999 NO LA QUISO DAR
City
Newborn
State
GA
Zip
30143-
Cell
(678) 557-1134
Family Status
Two parent family w/children
COB
USA
Gender
Female
Housing
Single Family
Education Level
College Degree
Home Owner
YES

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
G. Landeros
Data Entry
J. Manzo