Pancho - ACO-ZUL-53

Code: ACO-ZUL-53
Mercy ID: V-01706-01
Encounter Date: 09/16/2004
Last: Acosta
First: Zulma
DOB: 07/15/1953
County: Other
Street: 1233 Lake View Cove Dr.
City: Grayson
State: GA

Zip

30017-

Home

(678) 437-5682

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

Grade 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: 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