Pancho - AVA-MAR-55

Code: AVA-MAR-55
Mercy ID: B-00004-01
Encounter Date: 08/26/1998
Last: Avalos
First: Maria
DOB: 08/24/1955
County: Cobb
Street: 564 Little St. Apt. 7
City: Marietta
State: GA

Zip

30008-

Home

(770) 428-9609

Family Status

Unknow/Unreported

COB

Mexico

Gender

Female

Housing

Other

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: No
Relative: No
Stranger: No
Lives With: N/A
Name of School: N/A
Grade: N/A
Who Can't Pickup the Child
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: J. Perez
Data Entry: K. Aleman