Pancho - VAL-AMA-75

Code: VAL-AMA-75
Mercy ID: V-01652-01
Encounter Date: 07/07/2004
Last: Valencia salinas
First: Amalia
DOB: 07/09/1975
County: Dekalb
Street: P.O. Box 1327
City: Decatur
State: GA

Zip

30031-

Cell

(404) 297-5753

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Shelter

Education Level

Grade school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Amalia Valencia Salinas	N/A	Mexico
Father	Angel Mondragon	N/A	Mexico
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: No

Intake: J. Perez
Data Entry: K. Aleman