Pancho - CRU-MAR-81

Code: CRU-MAR-81
Mercy ID: V-02081-01
Encounter Date: 10/07/2005
Last: Cruz
First: Marisol
DOB: 02/15/1981
County: Cowetta
Street: 257 Est Rd Street #B104
City: Newnan
State: GA

Zip

30263-

Home

(770) 251-5581

Cell

(678) 849-6400

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

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: R. Gonzalez