Pancho - MUÑ-ROS-65

Code: MUÑ-ROS-65
Mercy ID: V-02009-01
Encounter Date: 09/06/2005
Last: Muñoz
First: Rosa maria
DOB: 08/26/1965
County: Other
Street: 415 North Side Dr. Apt A-2
City: Valdosta
State: GA

Zip

31602-

Home

(229) 630-7416

Family Status

Single parent 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: 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: J. Perez
Data Entry: K. Aleman