Pancho - VIV-CAR-68

Code: VIV-CAR-68
Mercy ID: V-01733-01
Encounter Date: 10/19/2004
Last: Viviano
First: Carmela
DOB: 07/05/1968
County: Fulton
Street: 4586 Roswell Rd. Apt D-2
City: Atlanta
State: GA

Zip

30342-

Home

(678) 622-1750

Family Status

Two parent family 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. Perez
Data Entry: K. Aleman