Pancho - BUS-ANA-59

Code: BUS-ANA-59
Mercy ID: B-00044-01
Encounter Date: 10/19/1998
Last: Bustamante
First: Ana
DOB: 02/21/1959
County: Dekalb
Street: 7080 Northern Place Apt 40
City: Doraville
State: GA

Zip

30360-

Home

(770) 522-0960

Family Status

Unknow/Unreported

COB

Mexico

Gender

Female

Housing

Other

Education Level

Other

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: K. Aleman