Pancho - URI-MIR-73

Code: URI-MIR-73
Mercy ID: V-00185-01
Encounter Date: 04/18/2000
Last: Uriostegui
First: Mirna
DOB: 01/18/1973
County: Dekalb
Street: 3398 Navaho Trl.
City: Smyrna
State: GA

Zip

30080-

Home

(770) 801-9051

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

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: 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: J. Perez
Data Entry: Y. Garcia