Pancho - MED-SHE-81

Code: MED-SHE-81
Mercy ID: V-03029-01
Encounter Date: 03/17/2009
Last: Medina
First: Sheila
DOB: 08/09/1981
County: Cherokee
Street: 6359 Bellsfferry Road Lot 298
City: Canton
State: GA

Zip

30102-

Cell

(678) 933-5629

Family Status

Adult couple-no children

COB

Puerto Rico

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: 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: G. Landeros
Data Entry: J. Manzo