Pancho - VEG-IRM-63

Code: VEG-IRM-63
Mercy ID: V-00123-01
Encounter Date: 02/25/2000
Last: Vega
First: Irma
DOB: 01/29/1963
County: Dekalb
Street: 3490 Chamblee Dunwoody
City: Chamblee
State: GA

Zip

30341-

Home

(770) 986-8841

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Child, not in school

Home Owner

YES

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: J. Perez
Data Entry: D. Gomez