Pancho - BAR-BER-58

Code: BAR-BER-58
Mercy ID: V-02354-01
Encounter Date: 10/17/2006
Last: Bardales
First: Bertilda
DOB: 12/12/1958
County: Dekalb
Street: 5032 Chamblee Tucker
City: Doraville
State: GA

Zip

30340-

Home

(678) 754-6562

Family Status

Two parent family w/children

COB

Honduras

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: J. Manzo