Pancho - CUA-AID-88

Code: CUA-AID-88
Mercy ID: V-02981-01
Encounter Date: 01/14/2009
Last: Cuadra
First: Aida
DOB: 02/02/1988
County: Cobb
Street: 1748 Waterfall Village
City: Marietta
State: GA

Zip

30067-

Cell

(404) 453-5785

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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