Pancho - MAL-EMM-64

Code: MAL-EMM-64
Mercy ID: V-01762-01
Encounter Date: 11/22/2004
Last: Maldonado
First: Emma
DOB: 04/27/1964
County: Dekalb
Street: 6654 Houseworth Lane
City: Lithonia
State: GA

Zip

30038-

Home

(770) 981-8436

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

Some College

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