Pancho - ROM-MAR-84

Code: ROM-MAR-84
Mercy ID: V-03504-01
Encounter Date: 01/05/2011
Last: Romero
First: Maria
DOB: 07/16/1984
County: Other
Street: 321 Aereopuerto Blvd.
City: Freedom
State: CA

Zip

95019-

Home

(831) 768-7831

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

Education Level

some high 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