Pancho - CAS-BLA-68

Code: CAS-BLA-68
Mercy ID: V-03349-01
Encounter Date: 06/22/2010
Last: Casiano
First: Blanca
DOB: 11/23/1968
County: Hall
Street: 5565 Mulberry St. # A-12
City: Flowery brnach ga
State: GA

Zip

30542-

Cell

(678) 592-0632

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Single Family

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: G. Landeros
Data Entry: J. Manzo