Pancho - VIQ-YOL-76

Code: VIQ-YOL-76
Mercy ID: V-01023-01
Encounter Date: 10/30/2002
Last: Viquez cuevas
First: Yolitza
DOB: 11/03/1976
County: Not given
Street: 0000 Some Street
City: Any city
State: GA

Zip

00000-0000

Home

(404) 944-7692

Family Status

Adult coupie-no children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: YES
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