Pancho - CER-KAR-84

Code: CER-KAR-84
Mercy ID: V-01215-01
Encounter Date: 04/14/2003
Last: Cervantes
First: Karina
DOB: 09/12/1984
County: Fulton
Street: 2601 Roselvett Hwy Apt. F7
City: Atlanta
State: GA

Zip

30337-

Home

(404) 684-2912

Family Status

Two parent family w/children

COB

Mexico

Gender

Female Child

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. Perez
Data Entry: K. Aleman