Pancho - DIA-EMY-70

Code: DIA-EMY-70
Mercy ID: V-00291-01
Encounter Date: 09/22/2000
Last: Diaz
First: Emily
DOB: 04/18/1970
County: Gwinnett
Street: 703 chelse ln
City: Norcross
State: GA

Zip

30093-

Home

(770) 921-4758

Family Status

Adult coupie-no children

COB

Colombia

Gender

Female

Housing

Not Homeless

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: 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: S. Aviña