Pancho - CAP-CAR-51

Code: CAP-CAR-51
Mercy ID: V-00371-01
Encounter Date: 12/27/2000
Last: Capelini
First: Carmenza
DOB: 02/03/1951
County: Cobb
Street: 206 Cherokee Dr.
City: Austell
State: GA

Zip

30168-

Home

(770) 739-7674

Family Status

Single adult

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

High school graduate

Home Owner

YES

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. Manzo
Data Entry: K. Aleman