BUS-JUL-99

Code
BUS-JUL-99
Mercy ID
B-00043-01
Encounter Date
06/02/1999
Last
Bustos
First
July
DOB
06/02/1999
County
Other
Street
Central Dr. #T
City
Stone mountain
State
GA
Zip
00000-0000
Home
(770) 465-3701
Family Status
Unknow/Unreported
COB
Mexico
Gender
Female
Housing
Other
Education Level
Other
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
DOB is the same as the encounter date because the DOB was not given
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
K. Aleman