Pancho - VIL-IRM-65

Code: VIL-IRM-65
Mercy ID: V-00436-01
Encounter Date: 02/28/2001
Last: Villa
First: Irma
DOB: 10/17/1965
County: Gwinnett
Street: 3991 Centenial Trl.
City: Duluth
State: GA

Zip

30096-

Home

(678) 580-5905

Cell

(770) 246-9915

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: 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