Pancho - EST-AZU-40

Code: EST-AZU-40
Mercy ID: V-01817-01
Encounter Date: 01/31/2005
Last: Estevez
First: Azucena
DOB: 02/17/1940
County: Other
Street: 235 Clifton Lane
City: Peachtree city
State: GA

Zip

30269-

Home

(770) 631-7895

Family Status

Adult coupie-no children

COB

Mexico

Gender

Female

Housing

Not Homeless

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: 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