Pancho - BLA-NAN-78

Code: BLA-NAN-78
Mercy ID: V-00059-01
Encounter Date: 01/28/2000
Last: Blanco
First: Nancy
DOB: 05/24/1978
County: Cobb
Street: 750 frankling rd Apt-27
City: Marietta
State: GA

Zip

30067-

Home

(678) 290-5722

Family Status

Two parent family 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: D. Gomez