Pancho - BRA-TER-54

Code: BRA-TER-54
Mercy ID: V-01094-01
Encounter Date: 01/22/2003
Last: Bravo
First: Teresa
DOB: 10/15/1954
County: Dekalb
Street: 2893 Arbor Creek Line
City: Doraville
State: GA

Zip

30340-

Home

(770) 457-5986

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Other

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