Pancho - MAR-ADE-55

Code: MAR-ADE-55
Mercy ID: V-02775-01
Encounter Date: 05/08/2008
Last: Martinez
First: Adela
DOB: 07/21/1955
County: Gwinnett
Street: 1658 Broofield Way
City: Lawrenceville
State: GA

Zip

30044-

Home

(678) 407-9678

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

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: J. Manzo