Pancho - CIS-MAR-65

Code: CIS-MAR-65
Mercy ID: V-00587-01
Encounter Date: 07/11/2001
Last: Cisneros
First: Maria
DOB: 02/07/1965
County: Gwinnett
Street: 1355 Graves Road Apt. o-4
City: Norcross
State: GA

Zip

30093-

Cell

(678) 789-5611

Family Status

Single parent w/children

COB

El Salvador

Gender

Female

Housing

Single Family

Education Level

Vocational/Technical

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: No
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