Pancho - DIA-TIR-83

Code: DIA-TIR-83
Mercy ID: V-02094-01
Encounter Date: 10/21/2005
Last: Diaz
First: Tirza
DOB: 09/15/1983
County: Dekalb
Street: 1559 Esquire Place
City: Norcross
State: GA

Zip

30093-

Home

(770) 938-5404

Family Status

Two parent family w/children

COB

El Salvador

Gender

Female

Housing

Doubling Up

Education Level

High school graduate

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