Pancho - VER-MAR-61

Code: VER-MAR-61
Mercy ID: V-00585-01
Encounter Date: 06/28/2001
Last: Vera
First: Maria
DOB: 08/28/1961
County: Clayton
Street: 1406 Buckingham Dr.
City: Hampton
State: GA

Zip

30228-

Home

(770) 477-7669

Family Status

Two parent family w/children

COB

Puerto Rico

Gender

Female

Housing

Not Homeless

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: YES
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. Manzo
Data Entry: K. Aleman