Pancho - IBA-EMA-89

Code: IBA-EMA-89
Mercy ID: V-01971-01
Encounter Date: 07/07/2005
Last: Ibarra sanchez
First: Ema
DOB: 10/14/1989
County: Other
Street: 630 Austell Rd. #203
City: Austell
State: GA

Zip

30168-

Home

(678) 945-7992

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Other

Education Level

Other

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