Pancho - CHA-ALM-74

Code: CHA-ALM-74
Mercy ID: V-01074-01
Encounter Date: 01/08/2003
Last: Chavez
First: Alma
DOB: 09/10/1974
County: Cobb
Street: 750 Franklin Rd. Apt. 21-E
City: Marietta
State: GA

Zip

00000-0000

Home

(678) 354-3217

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

some high 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. Manzo
Data Entry: K. Aleman