Pancho - MAC-IRM-83

Code: MAC-IRM-83
Mercy ID: V-02120-01
Encounter Date: 11/22/2005
Last: Macedo
First: Irma
DOB: 12/24/1983
County: Fulton
Street: 2572 Lenox Rd. I8
City: Atlanta
State: GA

Zip

30324-

Home

(404) 239-0466

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