CER-ESM-79

Code
CER-ESM-79
Mercy ID
V-00227-01
Encounter Date
02/24/2000
Last
Cervantes
First
Esmeralda
DOB
05/29/1979
County
Dekalb
Street
4009 covington rd
City
Covington
State
GA
Zip
30016-
Home
(770) 788-2205
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Shelter
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
YES
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. Manzo
Data Entry
D. Gomez