Pancho - CAB-MAR-73

Code: CAB-MAR-73
Mercy ID: V-03394-01
Encounter Date: 08/23/2010
Last: Cabrera
First: Maria agustina
DOB: 08/20/1973
County: Colquitt
Street: 657 Circle Rd.
City: Moultrie
State: GA

Zip

31768-

Cell

(229) 337-6136

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Single Family

Education Level

Child, not in 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