Pancho - RAM-BEN-53

Code: RAM-BEN-53
Mercy ID: V-00163-01
Encounter Date: 04/05/2000
Last: Ramirez
First: Benigna
DOB: 02/14/1953
County: Cobb
Street: 768 Roger Way
City: Marietta
State: GA

Zip

30064-

Home

(770) 541-6489

Family Status

Adult coupie-no 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: 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: D. Gomez