Pancho - PAS-MAR-80

Code: PAS-MAR-80
Mercy ID: V-01999-01
Encounter Date: 07/17/2005
Last: Pasos
First: Mariana
DOB: 05/26/1980
County: Fulton
Street: 5801 Kiffor Drive
City: Roswell
State: GA

Zip

30342-

Home

(404) 207-8574

Family Status

Single parent 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