Pancho - AVI-MAR-72

Code: AVI-MAR-72
Mercy ID: B-00030-01
Encounter Date: 11/19/1996
Last: Avila
First: Maria delia
DOB: 05/17/1972
County: Cobb
Street: 568 Wishire Ave.
City: Marietta
State: GA

Zip

30060-

Home

(770) 435-2561

Family Status

Adult coupie-no children

COB

Mexico

Gender

Female

Housing

Other

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: No
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: K. Aleman