Pancho - RIV-SAN-69

Code: RIV-SAN-69
Mercy ID: V-02002-01
Encounter Date: 07/25/2005
Last: Rivera
First: Sandra
DOB: 03/18/1969
County: Gwinnett
Street: 3078 Arden Rich Terrace
City: Suawnee
State: GA

Zip

30024-

Family Status

Two parent family w/children

COB

Nicaragua

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