Pancho - ACO-MAR-67

Code: ACO-MAR-67
Mercy ID: B-00019-01
Encounter Date: 01/20/1999
Last: Acosta
First: Maria
DOB: 11/12/1967
County: Other
Street: 123 Bridge Trail
City: Douglasville
State: GA

Zip

30134-

Home

(770) 947-8584

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

High school graduate

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: K. Aleman