Pancho - TOR-SUS-71

Code: TOR-SUS-71
Mercy ID: V-01314-01
Encounter Date: 08/18/2003
Last: Torrez
First: Susan
DOB: 12/15/1971
County: Cobb
Street: 325 Jaimaica Cove
City: Marietta
State: GA

Zip

30008-

Home

(770) 835-8265

Family Status

Two parent family w/children

COB

Ecuador

Gender

Female

Housing

Doubling Up

Education Level

College Degree

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: 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: K. Aleman