Pancho - AND-AMA-84

Code: AND-AMA-84
Mercy ID: V-01265-01
Encounter Date: 06/23/2003
Last: Andres
First: Amalia
DOB: 06/18/1984
County: Cobb
Street: 719 Shady Ln.
City: Marietta
State: GA

Zip

30008-

Home

(770) 419-8397

Family Status

Adult coupie-no children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

some high 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. Manzo
Data Entry: K. Aleman