Pancho - MED-KAR-74

Code: MED-KAR-74
Mercy ID: V-00565-01
Encounter Date: 05/17/2001
Last: Medina
First: Karla
DOB: 04/08/1974
County: Gwinnett
Street: 5780 Tine Rd.
City: Doraville
State: GA

Zip

30340-

Home

(770) 582-0783

Family Status

Single parent w/children

COB

Honduras

Gender

Female

Housing

Other

Education Level

College Degree

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