Pancho - PAC-RAQ-86

Code: PAC-RAQ-86
Mercy ID: V-02044-01
Encounter Date: 09/30/2005
Last: Pacheco
First: Raquelea
DOB: 04/02/1986
County: Dekalb
Street: 3559 Buford Hwy Apt 2
City: Doraville
State: GA

Zip

30360-

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: R. Gonzalez