Pancho - VAZ-MAR-60

Code: VAZ-MAR-60
Mercy ID: V-01119-01
Encounter Date: 02/13/2003
Last: Vazquez
First: Martha
DOB: 01/30/1960
County: Fulton
Street: 1368 West Austin Rd
City: Decatur
State: GA

Zip

30032-

Home

(404) 289-2632

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

Grade 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: 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