Pancho - FUE-PER-85

Code: FUE-PER-85
Mercy ID: V-01377-01
Encounter Date: 12/02/2003
Last: Fuentes
First: Perla
DOB: 10/21/1985
County: Dekalb
Street: 3564 Meadowglen Village
City: Doraville
State: GA

Zip

30340-

Home

(770) 572-8593

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

some high 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