COR-GEN-06

Code
COR-GEN-06
Mercy ID
V-03467-11
Encounter Date
12/08/2010
Last
Cortez
First
Genesis
DOB
12/14/2006
County
Fulton
Street
3360 Penny Lane # H
City
East point
State
GA
Zip
30344-
Cell
(817) 350-9064
Family Status
Child/Youth
COB
USA
Gender
Female Child
Housing
Single Family
Education Level
Child, not in school
Home Owner
YES

Parents Information

Name DOB COB
Mother Susana Acoltzi 02/22/1976 Mexico
Father Ricardo Cortez 12/19/1969 Mexico
Step Parent N/A N/A N/A
Driver
No
Relative
No
Stranger
No
NOTES
Lives With
Mother
Name of School
N/A
Grade
N/A
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
G. Landeros
Data Entry
J. Manzo