Pancho - QUI-MAR-65

Code: QUI-MAR-65
Mercy ID: V-00053-01
Encounter Date: 01/03/2000
Last: Quiroz
First: Maria
DOB: 04/30/1965
County: Cobb
Street: 105 Etheretge Rd
City: Temple
State: GA

Zip

30179-

Home

(770) 562-0112

Family Status

Single adult

COB

Costa Rica

Gender

Female

Housing

Not Homeless

Education Level

College Degree

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: D. Gomez