Pancho - RAM-ANG-85

Code: RAM-ANG-85
Mercy ID: V-01811-01
Encounter Date: 01/25/2005
Last: Ramirez
First: Angelica
DOB: 09/06/1985
County: Cobb
Street: 2754 Sanford Rd.
City: Smyrna
State: GA

Zip

30080-

Home

(770) 435-5535

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: K. Aleman