Pancho - BLA-ISA-72

Code: BLA-ISA-72
Mercy ID: V-01463-01
Encounter Date: 01/16/2004
Last: Blanco
First: Isabel
DOB: 05/22/1972
County: Fulton
Street: 2350 Cobb Parkway Apt E20 Apt G
City: Smyrna
State: GA

Zip

30080-

Home

(770) 955-4188

Cell

(404) 252-7347

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Vocational/Technical

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. Perez
Data Entry: K. Aleman