Pancho - BAU-AID-80

Code: BAU-AID-80
Mercy ID: V-03392-01
Encounter Date: 08/20/2010
Last: Bautista
First: Aida
DOB: 01/23/1980
County: Cobb
Street: 2345 Cobb Parkway
City: Smyrna
State: GA

Zip

30080-

Cell

(404) 438-3721

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

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: YES
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: YES
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: J. Perez
Data Entry: J. Manzo