Pancho - CHA-TIF-83

Code: CHA-TIF-83
Mercy ID: V-00999-01
Encounter Date: 08/20/2002
Last: Chavez
First: Tiffany
DOB: 01/03/1983
County: Fulton
Street: 6415 Short Road
City: Fairburn
State: GA

Zip

30213-

Home

(404) 964-9413

Family Status

Adult coupie-no children

COB

USA

Gender

Female

Housing

Not Homeless

Education Level

some high 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: 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. Perez
Data Entry: K. Aleman