Pancho - CAM-AND-70

Code: CAM-AND-70
Mercy ID: V-02950-01
Encounter Date: 11/24/2008
Last: Camarena
First: Andrea
DOB: 10/21/1970
County: Dekalb
Street: 5935 Tucker Road Circle
City: Chamblee
State: GA

Zip

30341-

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Preschool

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