Pancho - FUE-DIA-72

Code: FUE-DIA-72
Mercy ID: V-02629-01
Encounter Date: 10/23/2007
Last: Fuentes
First: Diana
DOB: 05/05/1972
County: Cherokee
Street: 112 Dupree Road #C-2
City: Woodstock
State: GA

Zip

30188-

Cell

(678) 651-9402

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

College Degree

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: G. Landeros
Data Entry: J. Manzo