Pancho - COR-DIA-76

Code: COR-DIA-76
Mercy ID: V-01841-01
Encounter Date: 02/21/2005
Last: Cortez
First: Diana
DOB: 07/06/1976
County: Cobb
Street: not given
City: Not given
State: GA

Zip

00000-

Home

(000) 000-0000

Family Status

Single parent w/children

COB

Honduras

Gender

Female

Housing

Shelter

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: 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: G. Landeros
Data Entry: K. Aleman