Pancho - GUT-ELI-80

Code: GUT-ELI-80
Mercy ID: V-01410-01
Encounter Date: 11/14/2003
Last: Gutierrez
First: Elizabeth
DOB: 06/21/1980
County: Gwinnett
Street: 2255 Sattlal Blv. Apt M202
City: Duluth
State: GA

Zip

30097-

Cell

(770) 906-0308

Family Status

Two parent family w/children

COB

Mexico

Gender

Female

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. Perez
Data Entry: K. Aleman