Pancho - ZEN-CAR-80

Code: ZEN-CAR-80
Mercy ID: V-02076-01
Encounter Date: 10/01/2005
Last: Zentle
First: Carmen joanna
DOB: 08/22/1980
County: Paulding
Street: 364 Clayde Cole Rd
City: Dallas
State: GA

Zip

30157-

Cell

(404) 456-1452

Family Status

Two parent family 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: 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