Pancho - ROD-RMA-75

Code: ROD-RMA-75
Mercy ID: V-03137-01
Encounter Date: 08/10/2009
Last: Rodriguez
First: Maria juana
DOB: 07/02/1975
County: Douglass
Street: 2945 Mill Ct.
City: Douglssville
State: GA

Zip

30135-

Home

(770) 949-3188

Family Status

Two parent family w/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: J. Perez
Data Entry: J. Manzo