Pancho - MAR-ROS-72

Code: MAR-ROS-72
Mercy ID: V-00068-01
Encounter Date: 02/14/2000
Last: Martinez
First: Rosa
DOB: 01/04/1972
County: Other
Street: 6465 HWY 9 Lot g-18
City: Alpharetta
State: GA

Zip

30004-

Home

(770) 664-7027

Family Status

Adult coupie-no children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

some high 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. Perez
Data Entry: Y. Garcia