Pancho - PIN-AND-80

Code: PIN-AND-80
Mercy ID: V-01962-01
Encounter Date: 07/13/2005
Last: Pineda hernandez
First: Andrea
DOB: 12/28/1980
County: Gwinnett
Street: 66 Patterson Rd.
City: Lawrenceville
State: GA

Zip

30044-

Cell

(404) 914-4688

Family Status

Two parent family w/children

COB

Guatemala

Gender

Female

Housing

Not Homeless

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