Pancho - COO-AMA-65

Code: COO-AMA-65
Mercy ID: V-02823-01
Encounter Date: 06/24/2008
Last: Cook
First: Amanda
DOB: 10/11/1965
County: Dekalb
Street: 2935 N. Dekalb Dr. #208
City: Atlanta
State: GA

Zip

30340-

Cell

(404) 781-3664

Family Status

Two parent family w/children

COB

USA

Gender

Female

Housing

Single Family

Education Level

High school graduate

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