ACO-SUS-76

Code
ACO-SUS-76
Mercy ID
V-03467-01
Encounter Date
12/01/2010
Last
Acoltzi
First
Susana
DOB
02/22/1976
County
Fulton
Street
3360 Penny Lane Apt H
City
East point
State
GA
Zip
30344-
Cell
(817) 350-9064
Family Status
Two parent family w/children
COB
Mexico
Gender
Female
Housing
Single Family
Education Level
College Degree
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

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