Pancho - MON-NOR-65

Code: MON-NOR-65
Mercy ID: V-01355-01
Encounter Date: 09/18/2003
Last: Monsalvo
First: Nora
DOB: 01/02/1965
County: Gwinnett
Street: 6493 Pleasendale Rd. Apt. A-1
City: Doravile
State: GA

Zip

30340-

Home

(770) 559-4500

Cell

(770) 846-6097

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Single Family

Education Level

Vocational/Technical

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: 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