Pancho - MON-MAR-85

Code: MON-MAR-85
Mercy ID: V-01915-01
Encounter Date: 05/31/2005
Last: Montufar
First: Maria
DOB: 01/28/1985
County: Fulton
Street: 20 Long Street
City: East point
State: GA

Zip

30344-

Home

(404) 468-2746

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Education Level

some high 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: 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: G. Landeros
Data Entry: K. Aleman