Pancho - VIO-MAR-60

Code: VIO-MAR-60
Mercy ID: V-00374-01
Encounter Date: 12/29/2000
Last: Violante
First: Maria
DOB: 10/05/1960
County: Cobb
Street: 2345 Cobb Parkway
City: Smyrna
State: GA

Zip

30080-

Home

(770) 952-9667

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Adult, no formal education

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: J. Manzo
Data Entry: K. Aleman