Pancho - PAD-MAR-55

Code: PAD-MAR-55
Mercy ID: V-01779-01
Encounter Date: 12/13/2004
Last: Padua
First: Maria yamileth
DOB: 12/12/1955
County: Gwinnett
Street: 5068 Burn Oak Rd NW
City: Lilburn
State: GA

Zip

30047-

Cell

(678) 914-3952

Family Status

Single adult

COB

Colombia

Gender

Female

Housing

Doubling Up

Education Level

Grade school

Home Owner

YES

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