Pancho - PER-LID-70

Code: PER-LID-70
Mercy ID: V-02037-01
Encounter Date: 09/21/2005
Last: Perez padilla
First: Lidia
DOB: 05/11/1970
County: Douglass
Street: 5682 Favor Rd
City: Douglasville
State: GA

Zip

30319-

Home

(770) 949-8517

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

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: 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: R. Gonzalez