Pancho - LLA-INE-53

Code: LLA-INE-53
Mercy ID: V-01805-01
Encounter Date: 01/17/2005
Last: Llaverias
First: Ines
DOB: 07/27/1953
County: Fulton
Street: 9265 MacKinc Dr.
City: Alpharetta
State: GA

Zip

30022-

Cell

(678) 520-9368

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

College Degree

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