Pancho - PUG-MAR-73

Code: PUG-MAR-73
Mercy ID: V-00370-01
Encounter Date: 12/27/2000
Last: Puga ruiz
First: Maria lourdes
DOB: 12/15/1973
County: Cobb
Street: 998 brendwood dr
City: Smyrna
State: GA

Zip

30082-

Home

(770) 431-4619

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: 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: K. Aleman