Pancho - MAN-GUA-80

Code: MAN-GUA-80
Mercy ID: V-00028-01
Encounter Date: 01/20/2000
Last: Mandujano lopez
First: Guadalupe
DOB: 06/11/1980
County: Fulton
Street: 1804 Richmond Circle Apt. 6
City: Atlanta
State: GA

Zip

30315-

Home

(404) 627-5425

Family Status

Single parent 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. Manzo
Data Entry: K. Aleman