Pancho - MER-PIE-69

Code: MER-PIE-69
Mercy ID: V-03185-01
Encounter Date: 10/19/2009
Last: Merino
First: Piedad
DOB: 11/24/1969
County: Clayton
Street: 7735 Tara Boulevard Lot #33
City: Jonesboro
State: GA

Zip

30236-

Home

(770) 472-7565

Family Status

Single parent w/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: 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