Pancho - ALB-MIN-66

Code: ALB-MIN-66
Mercy ID: V-02100-01
Encounter Date: 11/08/2005
Last: Alberto
First: Minerva
DOB: 02/22/1966
County: Clayton
Street: 4544 Luckett St
City: Forest park
State: GA

Zip

30297-

Home

(404) 361-2114

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

some high 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