DEL-FRA-05

Code
DEL-FRA-05
Mercy ID
V-03501-21
Encounter Date
01/19/2011
Last
De leon
First
Francisco
DOB
05/24/2005
County
Dekalb
Street
938 Brook View
City
Doraville
State
GA
Zip
30340-
Cell
(404) 292-1075
Family Status
Child/Youth
COB
USA
Gender
Male Child
Housing
Single Family
Education Level
Preschool
Home Owner
YES

Parents Information

Name DOB COB
Mother Sofia Mayorga 09/09/1980 Mexico
Father Cesar E. de Leon 07/04/1977 Mexico
Step Parent Miguel Angel Lopez 03/23/1987 Mexico
Driver
No
Relative
No
Stranger
No
Medical Alert
NOTES
ADD & Hiperactividad. No debe comer alimentos con azucar blanca o gaseosas con cafeina.
Lives With
Mother w/Stepfather
Name of School
Pleasandele Elem.
Grade
Kinder
Who Can't Pickup the Child

Media

NO DOY PERMISO
Authoritation Parent
YES
Authoritation Child
No
DOY PERMISO
YES
Limitado Educativo
No
Limitado Impresos
No
Limitado Caminar Latino
No
Intake
Volunteer
Data Entry
J. Manzo