Pancho - VAR-MIR-78

Code: VAR-MIR-78
Mercy ID: V-00051-01
Encounter Date: 02/23/2000
Last: Vargas
First: Mirian
DOB: 01/21/1978
County: Dekalb
Street: 3562 shallowford rd a-4
City: Chamblee
State: GA

Zip

30341-

Home

(770) 458-8047

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

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: 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. Manzo
Data Entry: S. Aviña