Pancho - AGU-CEC-77

Code: AGU-CEC-77
Mercy ID: V-02265-01
Encounter Date: 06/07/2006
Last: Agustin
First: Cecilia
DOB: 11/22/1977
County: Dekalb
Street: 3552 Chamblee Tucker Rd
City: Doraville
State: GA

Zip

30340-

Home

(770) 934-4013

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

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: 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: R. Gonzalez