Pancho - MAR-OMA-65

Code: MAR-OMA-65
Mercy ID: V-03339-01
Encounter Date: 06/04/2010
Last: Marulanda
First: Omaira
DOB: 01/22/1965
County: Walton
Street: 2407 Meretith Dr.
City: Loganville
State: GA

Zip

30052-

Cell

(678) 925-5878

Family Status

Two parent family w/children

COB

Colombia

Gender

Female

Housing

Single Family

Education Level

College Degree

Home Owner

YES

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