Pancho - SAN-MAR-80

Code: SAN-MAR-80
Mercy ID: V-02054-01
Encounter Date: 09/22/2005
Last: Santa maria
First: Martha
DOB: 02/16/1980
County: Gwinnett
Street: 5910 Hickory
City: Norcross
State: GA

Zip

30071-

Home

(678) 475-7414

Family Status

Two parent family w/children

COB

Ecuador

Gender

Female

Housing

Not Homeless

Education Level

Some College

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: R. Gonzalez