AYA-OLI-77

Code
AYA-OLI-77
Mercy ID
V-00411-01
Encounter Date
02/09/2001
Last
Ayala
First
Olivia
DOB
10/06/1977
County
Dekalb
Street
609-Apt. B-5 Allen Dr.
City
Riverdale
State
GA
Zip
30274-
Home
(404) 227-2280
Family Status
Single parent w/children
COB
Mexico
Gender
Female
Housing
Doubling Up
Education Level
Grade 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
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. Perez
Data Entry
Y. Garcia