Pancho - SAN-AMA-80

Code: SAN-AMA-80
Mercy ID: V-01828-01
Encounter Date: 02/12/2005
Last: Santamarina
First: Amanda
DOB: 02/06/1980
County: Other
Street: 3300 Godsrey Rd.
City: Madison
State: GA

Zip

30650-

Home

(706) 752-1930

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

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: YES
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