Pancho - BAS-KOR-63

Code: BAS-KOR-63
Mercy ID: V-01358-01
Encounter Date: 09/26/2003
Last: Basto
First: Korin
DOB: 12/11/1963
County: Gwinnett
Street: 4890 Gold Main Dr.
City: Sugar hill
State: GA

Zip

30518-

Home

(770) 271-2705

Family Status

Adult coupie-no children

COB

Colombia

Gender

Female

Housing

Doubling Up

Education Level

some high 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: J. Manzo
Data Entry: K. Aleman