Pancho - BUR-DOL-42

Code: BUR-DOL-42
Mercy ID: V-01977-01
Encounter Date: 07/06/2005
Last: Burns
First: Dolores
DOB: 07/26/1942
County: Dekalb
Street: 2243 Dresden Dr
City: Atlanta
State: GA

Zip

30341-

Cell

(404) 217-4620

Family Status

Adult coupie-no children

COB

USA

Gender

Female

Housing

Doubling Up

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: J. Perez
Data Entry: R. Gonzalez