Pancho - SAN-OTI-81

Code: SAN-OTI-81
Mercy ID: V-03197-01
Encounter Date: 10/27/2009
Last: Santiago
First: Otilia
DOB: 06/29/1981
County: Clayton
Street: 843 Warrant Drive
City: Forest park
State: GA

Zip

30297-

Cell

(404) 963-1357

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

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: 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