Pancho - ORT-AGU-69

Code: ORT-AGU-69
Mercy ID: V-01294-01
Encounter Date: 07/28/2003
Last: Ortiz
First: Agueda
DOB: 04/18/1969
County: Gwinnett
Street: 4917 Stort Ct.
City: Norcross
State: GA

Zip

30071-

Home

(678) 851-4787

Family Status

Single adult

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

some high 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: K. Aleman