Pancho - TEL-ANT-78

Code: TEL-ANT-78
Mercy ID: V-03116-01
Encounter Date: 07/08/2009
Last: Telles
First: Antonia
DOB: 01/17/1978
County: Clayton
Street: 4378 Hwy 42 Lot 4
City: Elenwood
State: GA

Zip

30294-

Cell

(404) 389-6634

Family Status

Single parent w/children

COB

Guatemala

Gender

Female

Housing

Single Family

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: G. Landeros
Data Entry: J. Manzo