Pancho - OBR-MIC-63

Code: OBR-MIC-63
Mercy ID: V-00392-01
Encounter Date: 01/23/2001
Last: Obrien
First: Michelle
DOB: 11/16/1963
County: Cherokee
Street: 270 mclain st.
City: Canton
State: GA

Zip

30114-

Home

(678) 313-5388

Family Status

Single adult

COB

USA

Gender

Female

Housing

Not Homeless

Education Level

High school graduate

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. Manzo
Data Entry: S. Aviña