Pancho - MAR-MAI-69

Code: MAR-MAI-69
Mercy ID: V-01899-01
Encounter Date: 04/25/2005
Last: Marin
First: Maria isabel
DOB: 01/13/1969
County: Clayton
Street: 175 Glenn Road #324
City: Fairburn
State: GA

Zip

30213-

Cell

(678) 497-7676

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Single Family

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: 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: G. Landeros
Data Entry: K. Aleman