Pancho - DEL-MAR-77

Code: DEL-MAR-77
Mercy ID: V-01728-01
Encounter Date: 10/08/2004
Last: De la fox
First: Maria dolores
DOB: 04/07/1977
County: Gwinnett
Street: 1409 Wesley Plantatation Dr.
City: Duluth
State: GA

Zip

30096-

Home

(678) 924-1057

Cell

(770) 368-9599

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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. Manzo
Data Entry: K. Aleman