Pancho - LUN-NIC-72

Code: LUN-NIC-72
Mercy ID: V-00787-01
Encounter Date: 12/31/2001
Last: Luna
First: Nicole
DOB: 12/07/1972
County: Clayton
Street: 1606 Dayna Dr.
City: Atlanta
State: GA

Zip

30349-

Home

(770) 996-3224

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

Vocational/Technical

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. Manzo
Data Entry: K. Aleman