Pancho - DOM-GUA-55

Code: DOM-GUA-55
Mercy ID: V-01324-01
Encounter Date: 08/22/2003
Last: Dominguez
First: Guadalupe
DOB: 12/08/1955
County: Dekalb
Street: 2515 Northeast Expressway Rd. #-D-4
City: Atlanta
State: GA

Zip

30345-

Home

(404) 634-5156

Cell

(678) 548-7252

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

Grade school

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: G. Landeros
Data Entry: K. Aleman