Pancho - CAM-LOR-77

Code: CAM-LOR-77
Mercy ID: V-02751-01
Encounter Date: 04/01/2008
Last: Campa
First: Lorena
DOB: 10/22/1977
County: Dekalb
Street: 5100 West Mountain St. # A201
City: Stone mountain
State: GA

Zip

30083-

Home

(770) 413-5513

Family Status

Adult couple-no children

COB

Mexico

Gender

Female

Housing

Doubling Up

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