Pancho - CON-VER-81

Code: CON-VER-81
Mercy ID: V-02643-01
Encounter Date: 11/13/2007
Last: Contreras
First: Veronica
DOB: 06/29/1981
County: Cowetta
Street: 999 no la dio
City: Newman
State: GA

Zip

99999-9999

Cell

(678) 252-7484

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Shelter

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