Pancho - COR-EMI-82

Code: COR-EMI-82
Mercy ID: V-02963-01
Encounter Date: 12/08/2008
Last: Cursino
First: Emiliana
DOB: 08/17/1982
County: Henry
Street: 328 McChadler Ridge
City: Mcdonough
State: GA

Zip

30253-

Home

(678) 583-6321

Family Status

Adult couple-no children

COB

Dominican Rep

Gender

Female

Housing

Single Family

Education Level

College Degree

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