Pancho - LEG-ADR-70

Code: LEG-ADR-70
Mercy ID: V-02495-01
Encounter Date: 05/18/2007
Last: Legarza
First: Adrina
DOB: 09/13/1970
County: Clayton
Street: 330 Arrowheead Boulevard # 8-C
City: Jonesboro
State: GA

Zip

32360-

Cell

(678) 499-0501

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: G. Landeros
Data Entry: J. Manzo