Pancho - BAR-CAR-87

Code: BAR-CAR-87
Mercy ID: V-02211-01
Encounter Date: 03/27/2006
Last: Varela
First: Carmen
DOB: 07/16/1978
County: Dekalb
Street: 2235 Place Rd.
City: Chamblee
State: GA

Zip

30345-

Home

(678) 789-3870

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

Preschool

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: YES
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