Pancho - CAR-MAR-75

Code: CAR-MAR-75
Mercy ID: V-00864-01
Encounter Date: 03/25/2002
Last: Carrasco
First: Maria guadalupe
DOB: 12/12/1975
County: Gwinnett
Street: 4553 Burns Rd.
City: Lilburn
State: GA

Zip

30047-

Home

(770) 923-4081

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Some College

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