Pancho - VAZ-AME-60

Code: VAZ-AME-60
Mercy ID: V-03264-01
Encounter Date: 02/11/2010
Last: Vazquez
First: Amelia
DOB: 11/25/1960
County: Clayton
Street: 1418 Park Dr. Lot 250
City: Forest park
State: GA

Zip

30297-

Cell

(678) 231-0476

Family Status

Two parent family 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: 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: G. Landeros
Data Entry: J. Manzo