Pancho - VER-MAR-81

Code: VER-MAR-81
Mercy ID: V-02124-01
Encounter Date: 12/20/2005
Last: Vergara
First: Martha
DOB: 08/25/1981
County: Dekalb
Street: 3504 Chamblee Dunwoody Way
City: Chamblee
State: GA

Zip

30341-

Home

(404) 816-7320

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