Pancho - VAC-CAT-70

Code: VAC-CAT-70
Mercy ID: V-02682-01
Encounter Date: 12/28/2007
Last: Vaca
First: Catalina
DOB: 05/05/1970
County: Dekalb
Street: 5297 Chamblee Tucker Road
City: Chamblee
State: GA

Zip

30341-

Cell

(678) 529-1890

Family Status

Single parent w/children

COB

El Salvador

Gender

Female

Housing

Doubling Up

Education Level

Grade school

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