Pancho - ORT-ANA-69

Code: ORT-ANA-69
Mercy ID: V-02700-01
Encounter Date: 01/31/2008
Last: Ortiz
First: Ana
DOB: 05/16/1969
County: Clayton
Street: 6153 Twilight Trail
City: Morrow
State: GA

Zip

30260-

Cell

(404) 395-5655

Family Status

Single adult

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

some high 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: G. Landeros
Data Entry: J. Manzo