Pancho - PAD-NOR-79

Code: PAD-NOR-79
Mercy ID: V-03095-01
Encounter Date: 06/23/2009
Last: Padilla
First: Norma
DOB: 11/22/1979
County: Douglass
Street: 7631 Dallas Hwy A-11
City: Douglasville
State: GA

Zip

30135-

Cell

(678) 521-4651

Family Status

Single adult

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