Pancho - SOL-AMY-70

Code: SOL-AMY-70
Mercy ID: V-00078-01
Encounter Date: 07/21/1999
Last: Soliz
First: Amy
DOB: 10/11/1970
County: Cherokee
Street: 1212 Hwy #34
City: Acworth
State: GA

Zip

30102-

Home

(713) 733-1312

Family Status

Two parent family w/children

COB

USA

Gender

Female

Housing

Other

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. Perez
Data Entry: D. Gomez