Pancho - AMA-PET-75

Code: AMA-PET-75
Mercy ID: V-02443-01
Encounter Date: 03/26/2007
Last: Amaya
First: Petrona
DOB: 08/22/1975
County: Gwinnett
Street: 2367 Planters Court Dr.
City: Lawrenceville
State: GA

Zip

30044-

Cell

(770) 896-2808

Family Status

Single parent w/children

COB

El Salvador

Gender

Female

Housing

Transitional

Education Level

High school graduate

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: G. Landeros
Data Entry: J. Manzo