Pancho - TAV-PAU-72

Code: TAV-PAU-72
Mercy ID: V-03215-01
Encounter Date: 11/25/2009
Last: Tavares
First: Paulina
DOB: 06/22/1972
County: Dekalb
Street: 3224 Mercer University Dr. 316
City: Chamblee
State: GA

Zip

30341-

Cell

(404) 453-2054

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

Education Level

Vocational/Technical

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