Pancho - GUZ-MON-80

Code: GUZ-MON-80
Mercy ID: V-01887-01
Encounter Date: 04/13/2005
Last: Guzman
First: Monica
DOB: 01/19/1980
County: Gwinnett
Street: 2007 Hunters Club
City: Norcross
State: GA

Zip

30093-

Home

(770) 491-3079

Family Status

Unknow/Unreported

COB

Mexico

Gender

Female

Housing

Other

Education Level

Other

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: G. Landeros
Data Entry: K. Aleman