DIA-MAR-68

Code
DIA-MAR-68
Mercy ID
V-00397-01
Encounter Date
01/24/2001
Last
Diaz
First
Mariela
DOB
05/24/1968
County
Dekalb
Street
512 N. Summit St.
City
Stone mountain
State
GA
Zip
30088-
Home
(404) 294-9982
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Vocational/Technical
Home Owner
YES

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
Signed consent form and promesa before the fire
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