Pancho - ORT-MAR-73

Code: ORT-MAR-73
Mercy ID: V-00191-01
Encounter Date: 04/26/2000
Last: Ortiz
First: Margarita
DOB: 09/17/1973
County: Gwinnett
Street: 5881 park Rd
City: Doraville
State: GA

Zip

30340-

Home

(770) 441-5865

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: 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. Manzo
Data Entry: D. Gomez