Pancho - ISA-IRM-79

Code: ISA-IRM-79
Mercy ID: V-00779-01
Encounter Date: 12/19/2001
Last: Isais
First: Irma
DOB: 08/09/1979
County: Gwinnett
Street: 6200 Edward St.
City: Doraville
State: GA

Zip

30340-

Home

(770) 242-3565

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: 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