Pancho - GAM-MAR-70

Code: GAM-MAR-70
Mercy ID: V-02834-01
Encounter Date: 06/25/2008
Last: Gamboa
First: Maribel
DOB: 09/15/1970
County: Cobb
Street: 3095 Palomino Dr.
City: Power spring
State: GA

Zip

30127-

Home

(678) 402-5631

Cell

(678) 732-6206

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

some high 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: 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