Pancho - ORT-NAN-77

Code: ORT-NAN-77
Mercy ID: V-01771-01
Encounter Date: 12/06/2004
Last: Ortiz
First: Nancy
DOB: 10/29/1977
County: Barrow
Street: 109 Larkwood Cir
City: Caterville
State: GA

Zip

30120-

Home

(678) 977-7981

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

Vocational/Technical

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