Pancho - RAY-VER-79

Code: RAY-VER-79
Mercy ID: V-01405-01
Encounter Date: 11/05/2003
Last: Raya
First: Veronica
DOB: 03/05/1979
County: Dekalb
Street: 3096 Buford Hwy Apt D
City: Atlanta
State: GA

Zip

30329-

Home

(404) 325-0141

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: YES
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