Pancho - PAC-EUS-60

Code: PAC-EUS-60
Mercy ID: V-01195-01
Encounter Date: 04/21/2003
Last: Pacheco
First: Eustolia
DOB: 09/22/1960
County: Hall
Street: 1617 North Park Hill C-6
City: Gainsville
State: GA

Zip

30501-

Home

(678) 450-4798

Family Status

Single adult

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: 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: K. Aleman