Pancho - FON-ANA-87

Code: FON-ANA-87
Mercy ID: V-02749-01
Encounter Date: 04/02/2008
Last: Fonseca
First: Ana
DOB: 05/18/1987
County: Fulton
Street: P.O. Box 78935
City: Atlanta
State: GA

Zip

30357-

Cell

(404) 551-0744

Family Status

Single parent w/children

COB

El Salvador

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