Pancho - GUI-MAR-72

Code: GUI-MAR-72
Mercy ID: V-01440-01
Encounter Date: 12/11/2003
Last: Guillen
First: Maria
DOB: 06/09/1972
County: Fulton
Street: 390 Erwing ST.
City: Atlanta
State: GA

Zip

30312-

Home

(404) 522-3188

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

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: 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: K. Aleman