Pancho - MED-MAR-62

Code: MED-MAR-62
Mercy ID: V-00975-01
Encounter Date: 07/22/2002
Last: Medina
First: Maria
DOB: 10/07/1962
County: Gwinnett
Street: 2630 Millpond CT.
City: Duluth
State: GA

Zip

30096-

Home

(770) 246-6153

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

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