Pancho - WHI-COL-64

Code: WHI-COL-64
Mercy ID: V-00083-01
Encounter Date: 08/25/1999
Last: Whitman
First: Collen
DOB: 03/18/1964
County: Dekalb
Street: 3236 mathirson dr ne
City: Atlanta
State: GA

Zip

30305-

Home

(404) 812-0077

Family Status

Two parent family w/children

COB

Other

Gender

Female

Housing

Other

Education Level

Some College

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: S. Aviña