Pancho - RIV-TER-60

Code: RIV-TER-60
Mercy ID: V-01467-01
Encounter Date: 01/21/2004
Last: Rivas lopez
First: Teresa
DOB: 10/03/1960
County: Dekalb
Street: 6750 Peachtree St. Industrial #304
City: Doraville
State: GA

Zip

30360-

Home

(770) 613-9625

Family Status

Adult coupie-no children

COB

Mexico

Gender

Female

Housing

Doubling Up

Education Level

some high 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: 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