Pancho - DIA-FLO-67

Code: DIA-FLO-67
Mercy ID: V-01411-01
Encounter Date: 11/11/2003
Last: Diaz
First: Flor
DOB: 04/01/1967
County: Gwinnett
Street: 1454 Sydney Pond Cr.
City: Lawrenceville
State: GA

Zip

30045-

Home

(678) 407-2704

Cell

(678) 860-1111

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

Some College

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: J. Perez
Data Entry: K. Aleman