Pancho - QUI-AMA-65

Code: QUI-AMA-65
Mercy ID: V-01009-01
Encounter Date: 09/05/2002
Last: Quintero
First: Amalia
DOB: 12/25/1965
County: Cowetta
Street: 412 Old Carrollton Rd.
City: Newman
State: GA

Zip

30263-

Home

(678) 423-0770

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

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: K. Aleman