Pancho - CHA-MAR-68

Code: CHA-MAR-68
Mercy ID: V-03441-01
Encounter Date: 10/12/2010
Last: Chacon
First: Martha
DOB: 11/26/1968
County: Gwinnett
Street: 6474 Summit Point Dr.
City: Norcross
State: GA

Zip

30092-

Cell

(770) 866-7408

Family Status

Two parent family w/children

COB

Ecuador

Gender

Female

Housing

Doubling Up

Education Level

Grade school

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

Intake: J. Perez
Data Entry: J. Manzo