Pancho - CAM-CLA-73

Code: CAM-CLA-73
Mercy ID: V-00334-01
Encounter Date: 11/07/2000
Last: Campos
First: Claudia
DOB: 09/25/1973
County: Cobb
Street: 114 hillcrest chase terrace
City: Austell
State: GA

Zip

30168-

Home

(770) 944-3122

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

High school graduate

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: YES
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: D. Gomez