Pancho - BAR-ROS-70

Code: BAR-ROS-70
Mercy ID: B-00008-01
Encounter Date: 09/03/1999
Last: Barrera
First: Rosa
DOB: 11/27/1970
County: Not given
Street: 1353 Clssvall Lake apt. G
City: Chamblee
State: GA

Zip

30319-

Home

(404) 634-5273

Family Status

Unknow/Unreported

COB

Other

Gender

Female

Housing

Other

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: 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. Perez
Data Entry: Y. Garcia