Pancho - GUT-ANA-70

Code: GUT-ANA-70
Mercy ID: V-01963-01
Encounter Date: 07/15/2005
Last: Gutierrez
First: Ana lilia
DOB: 06/13/1970
County: Forsyth
Street: 5110 Virginia Ave.
City: Cumming
State: GA

Zip

30041-

Home

(770) 374-0820

Family Status

Single parent w/children

COB

Mexico

Gender

Female

Housing

Not Homeless

Education Level

High school graduate

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