Pancho - CAM-EMI-76

Code: CAM-EMI-76
Mercy ID: V-01872-01
Encounter Date: 04/08/2005
Last: Campos
First: Emilzan
DOB: 04/10/1976
County: Dekalb
Street: 1096 Atlanta J.
City: Marietta
State: GA

Zip

00000-0000

Cell

(404) 732-2853

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Grade 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: G. Landeros
Data Entry: K. Aleman