Pancho - MAY-ADE-73

Code: MAY-ADE-73
Mercy ID: V-01424-01
Encounter Date: 11/24/2003
Last: Maya
First: Adela
DOB: 06/17/1973
County: Dekalb
Street: 3353 B Peachtree Corner Cr.
City: Norcross
State: GA

Zip

30092-

Cell

(770) 895-5016

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

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: YES

Intake: J. Perez
Data Entry: K. Aleman