Pancho - ADA-ARG-64

Code: ADA-ARG-64
Mercy ID: B-00034-01
Encounter Date: 07/28/1998
Last: Adame
First: Argelia
DOB: 01/23/1964
County: Other
Street: Power Springs
City: Power springs
State: GA

Zip

00000-0000

Home

(770) 943-0725

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