Pancho - DIA-MAR-49

Code: DIA-MAR-49
Mercy ID: V-03131-01
Encounter Date: 08/03/2009
Last: Diaz
First: Maria felix
DOB: 06/11/1949
County: Cobb
Street: 730 Franklin Road Apt. K-7
City: Marietta
State: GA

Zip

30067-

Cell

(770) 895-1374

Family Status

Adult couple-no children

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