Pancho - AVI-ANA-69

Code: AVI-ANA-69
Mercy ID: V-00791-01
Encounter Date: 01/09/2002
Last: Avila
First: Ana
DOB: 05/10/1969
County: Cobb
Street: 514 Park Bridge N.W.
City: Acworth
State: GA

Zip

30010-

Home

(678) 574-8925

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

College Degree

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