Pancho - ORT-ANA-83

Code: ORT-ANA-83
Mercy ID: V-00969-01
Encounter Date: 07/10/2002
Last: Ortega estrada
First: Ana
DOB: 05/11/1983
County: Other
Street: P.O. Box 1160
City: Cumming
State: GA

Zip

30028-

Home

(770) 889-6579

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Shelter

Education Level

Grade 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: YES
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