Pancho - MAY-GLA-59

Code: MAY-GLA-59
Mercy ID: V-01417-01
Encounter Date: 11/17/2003
Last: Mayorga
First: Gladis
DOB: 04/16/1959
County: Dekalb
Street: 4920 Winter Chapel Rd. Apt. K2
City: Doraville
State: GA

Zip

30360-

Home

(770) 396-5808

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

Grade school

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: No
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