Pancho - GAY-MAR-78

Code: GAY-MAR-78
Mercy ID: V-02332-01
Encounter Date: 09/26/2006
Last: Gaytan
First: Maria
DOB: 11/18/1978
County: Cobb
Street: 1613 Bridge Mill Dr. # K
City: Marietta
State: GA

Zip

30067-

Home

(678) 789-1476

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

Preschool

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: J. Manzo