Pancho - BAR-MON-83

Code: BAR-MON-83
Mercy ID: V-03195-01
Encounter Date: 10/27/2009
Last: Barrita
First: Monica
DOB: 11/04/1983
County: Dekalb
Street: 416 Brook Ridge
City: Doraville
State: GA

Zip

30340-

Cell

(678) 760-1859

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Single Family

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