Pancho - AMA-MAR-64

Code: AMA-MAR-64
Mercy ID: B-00024-01
Encounter Date: 07/20/1964
Last: Amaya
First: Maria
DOB: 07/20/1964
County: Clayton
Street: 928 Dearing St.
City: Forest park
State: GA

Zip

30297-

Home

(404) 363-2477

Family Status

Adult coupie-no children

COB

Mexico

Gender

Female

Housing

Other

Education Level

Other

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: J. Perez
Data Entry: K. Aleman