Code
RUB-KAT-00
Mercy ID
V-01749-11
Last
Rubio
First
Katherine
DOB
09/03/2000
County
Gwinnett
House
(000) 000-0000
CODE DATE SERVICE INTAKE BY CONTACT MODE DATA ENTRY
RUB-KAT-00 11/03/2004 Intake J. Perilla Face to face K. Aleman