Pancho - AYA-REY-98

Code: AYA-REY-98
Mercy ID: B-00020-01
Encounter Date: 05/05/1998
Last: Ayala
First: Reyna
DOB: 12/12/1969
County: Other
Street: 3427 Cumberland Apt 2
City: Chamblee
State: GA

Zip

30341-

Home

(770) 457-8931

Family Status

Adult coupie-no children

COB

Mexico

Gender

Female

Housing

Other

Education Level

Other

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