Pancho - TEC-CLA-82

Code: TEC-CLA-82
Mercy ID: V-02162-01
Encounter Date: 02/05/2006
Last: Tomulata
First: Clara
DOB: 06/05/1982
County: Fulton
Street: 3510 Buford Hwy
City: Atlanta
State: GA

Zip

30329-

Cell

(404) 246-3040

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: YES
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