Pancho - PED-EVA-57

Code: PED-EVA-57
Mercy ID: V-03479-01
Encounter Date: 11/29/2010
Last: Pedrosa
First: Evangelina
DOB: 05/30/1957
County: Clayton
Street: 129 Fharon Dr.
City: Riverdale
State: GA

Zip

30296-

Cell

(678) 270-7580

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

Intake: G. Landeros
Data Entry: J. Manzo