Pancho - MEN-ROS-65

Code: MEN-ROS-65
Mercy ID: V-01954-01
Encounter Date: 06/29/2005
Last: Mendoza
First: Rosa
DOB: 08/30/1965
County: Dekalb
Street: Not given
City: Not given
State: GA

Zip

N/A

Home

(000) 000-0000

Family Status

Single adult

COB

Mexico

Gender

Female

Housing

Shelter

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: 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: G. Landeros
Data Entry: K. Aleman