Pancho - MAR-VIC-77

Code: MAR-VIC-77
Mercy ID: V-01350-01
Encounter Date: 09/09/2003
Last: Martinez
First: Vicenta
DOB: 09/11/1977
County: Dekalb
Street: 4715 Buford Hwy Apt. C
City: Chamblee
State: GA

Zip

30341-

Home

(770) 454-0261

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: 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. Perez
Data Entry: K. Aleman