Pancho - TAP-BEN-68

Code: TAP-BEN-68
Mercy ID: V-00037-01
Encounter Date: 01/17/2000
Last: Tapia
First: Benita
DOB: 02/12/1968
County: Dekalb
Street: 3629 admiral dr
City: Chamblee
State: GA

Zip

30341-

Home

(770) 457-3257

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: 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. Manzo
Data Entry: S. Aviña