Pancho - CID-VER-76

Code: CID-VER-76
Mercy ID: V-02026-01
Encounter Date: 09/13/2005
Last: Cid
First: Veronica
DOB: 04/01/1976
County: Dekalb
Street: 3559 Pleasant Brook Village Lane
City: Doraville
State: GA

Zip

30340-

Home

(678) 534-1297

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

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: G. Landeros
Data Entry: K. Aleman