Pancho - RUB-MAR-70

Code: RUB-MAR-70
Mercy ID: V-01235-01
Encounter Date: 05/20/2003
Last: Rubio
First: Maria
DOB: 06/06/1970
County: Other
Street: 458 Bill Road Ridge Rd.
City: Winder
State: GA

Zip

30680-

Home

(770) 569-9588

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Grade school

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: 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