Pancho - MAG-PAT-76

Code: MAG-PAT-76
Mercy ID: V-03176-01
Encounter Date: 09/28/2009
Last: Magaña
First: Patricia
DOB: 11/19/1976
County: Hall
Street: 9999 En una Iglesia
City: Gainsville
State: GA

Zip

30501-

Cell

(678) 989-9861

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Other

Education Level

some high 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: 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