Pancho - MEN-MER-67

Code: MEN-MER-67
Mercy ID: V-03074-01
Encounter Date: 05/18/2009
Last: Mencos
First: Mercedes
DOB: 11/22/1967
County: Gordon
Street: 2510 Peachtree Road # 18
City: Calhoun
State: GA

Zip

30701-

Cell

(678) 848-0484

Family Status

Single parent w/children

COB

El Salvador

Gender

Female

Housing

Single Family

Education Level

Grade 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