Pancho - CER-SIL-68

Code: CER-SIL-68
Mercy ID: V-01638-01
Encounter Date: 06/28/2004
Last: Cervantes
First: Silvia
DOB: 10/14/1968
County: Dekalb
Street: 2589 Shallowford Rd. Apt 116
City: Chamblee
State: GA

Zip

30345-

Home

(404) 437-1570

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